Provider Demographics
NPI:1386775856
Name:WEGLARZ, RONALD (PSYD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:WEGLARZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19530 KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1778
Mailing Address - Country:US
Mailing Address - Phone:708-799-2200
Mailing Address - Fax:708-799-2711
Practice Address - Street 1:19530 KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1778
Practice Address - Country:US
Practice Address - Phone:708-799-2200
Practice Address - Fax:708-799-2711
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL372940Medicare ID - Type Unspecified