Healthcare Provider Details

I. General information

NPI: 1487723490
Provider Name (Legal Business Name): VIRGINIA ANN GEMMELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W LAKE ST
ADDISON IL
60101-2086
US

IV. Provider business mailing address

743 S 2ND ST
SAINT CHARLES IL
60174-3904
US

V. Phone/Fax

Practice location:
  • Phone: 630-715-6390
  • Fax: 630-458-0176
Mailing address:
  • Phone: 630-584-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: