Provider Demographics
NPI:1033806732
Name:GUZMAN, EDWIN (MS, CRC, LCPC)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:MS, CRC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14617 S ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:POSEN
Mailing Address - State:IL
Mailing Address - Zip Code:60469-1103
Mailing Address - Country:US
Mailing Address - Phone:708-897-5223
Mailing Address - Fax:
Practice Address - Street 1:5000 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180016232101YP2500X
IL586237225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional