Healthcare Provider Details

I. General information

NPI: 1255295820
Provider Name (Legal Business Name): DR. GAYLENA LAWRENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 BOHLAND AVE
BELLWOOD IL
60104-1833
US

IV. Provider business mailing address

2550 BILTMORE CIR
AURORA IL
60503-5653
US

V. Phone/Fax

Practice location:
  • Phone: 630-209-5635
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: