Provider Demographics
NPI:1366237927
Name:MUNGUIA, NATALIE MARIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIE
Last Name:MUNGUIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 LIBERTY BLVD # 13AAND3B
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1351
Mailing Address - Country:US
Mailing Address - Phone:630-426-9386
Mailing Address - Fax:
Practice Address - Street 1:4101 LIBERTY BLVD # 13AAND3B
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1351
Practice Address - Country:US
Practice Address - Phone:630-426-9386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist