Provider Demographics
NPI:1912880907
Name:ENGQUIST, AUSTIN JAMES
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JAMES
Last Name:ENGQUIST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14913 W RUSSELL RD APT 1W
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-9234
Mailing Address - Country:US
Mailing Address - Phone:224-456-6130
Mailing Address - Fax:
Practice Address - Street 1:2814 GABRIEL AVE
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-2526
Practice Address - Country:US
Practice Address - Phone:224-456-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBACB1331118106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician