Healthcare Provider Details

I. General information

NPI: 1982906319
Provider Name (Legal Business Name): JULIE TEPKE GURGONE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 N. OAKLEY BLVD 3RD FLOOR
CHICAGO IL
60622
US

IV. Provider business mailing address

1127 N OAKLEY BLVD 3RD FLOOR
CHICAGO IL
60622-3507
US

V. Phone/Fax

Practice location:
  • Phone: 312-770-2603
  • Fax:
Mailing address:
  • Phone: 312-770-2603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178006284
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180008670
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: