Healthcare Provider Details

I. General information

NPI: 1861475253
Provider Name (Legal Business Name): DEBORAH CLEMENTS GESSNER MA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 N WABASH AVE ST JAMES CATHEDRAL COUNSELING CENTER
CHICAGO IL
60611
US

IV. Provider business mailing address

5463 S RIDGEWOOD CT
CHICAGO IL
60615
US

V. Phone/Fax

Practice location:
  • Phone: 312-337-5874
  • Fax: 312-337-9243
Mailing address:
  • Phone: 773-947-9384
  • Fax:

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: