Healthcare Provider Details

I. General information

NPI: 1730206921
Provider Name (Legal Business Name): PATRICIA GIBBONS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S. RIVER ST
AURORA IL
60506-5178
US

IV. Provider business mailing address

36W312 BARTON DR
ST CHARLES IL
60175-6310
US

V. Phone/Fax

Practice location:
  • Phone: 630-844-2662
  • Fax: 630-844-3084
Mailing address:
  • Phone: 630-584-1327
  • Fax: 630-584-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: