Provider Demographics
NPI:1184352544
Name:ERIN GUSTAFSON CONSULTING PLLC
Entity type:Organization
Organization Name:ERIN GUSTAFSON CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:574-274-9054
Mailing Address - Street 1:1135 W GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4313
Mailing Address - Country:US
Mailing Address - Phone:574-274-9054
Mailing Address - Fax:
Practice Address - Street 1:3547 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3945
Practice Address - Country:US
Practice Address - Phone:574-274-9054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty