Healthcare Provider Details

I. General information

NPI: 1669279097
Provider Name (Legal Business Name): LYDIA JADE GEDMIN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 N ISLAND AVE STE F
BATAVIA IL
60510-1996
US

IV. Provider business mailing address

34 N ISLAND AVE STE F
BATAVIA IL
60510-1996
US

V. Phone/Fax

Practice location:
  • Phone: 630-216-5458
  • Fax:
Mailing address:
  • Phone: 815-216-5458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150116176
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: