Healthcare Provider Details

I. General information

NPI: 1821652942
Provider Name (Legal Business Name): CRYSTAL GEBRE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E TOUHY AVE
DES PLAINES IL
60018-5801
US

IV. Provider business mailing address

1001 E TOUHY AVE
DES PLAINES IL
60018-5801
US

V. Phone/Fax

Practice location:
  • Phone: 224-355-9118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149020917
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: