Healthcare Provider Details

I. General information

NPI: 1336058916
Provider Name (Legal Business Name): LAVITA GIGI GAYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 W JACKSON BLVD STE 1210
CHICAGO IL
60604-3525
US

IV. Provider business mailing address

53 W JACKSON BLVD STE 1210
CHICAGO IL
60604-3525
US

V. Phone/Fax

Practice location:
  • Phone: 312-912-7008
  • Fax:
Mailing address:
  • Phone: 312-912-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: