Healthcare Provider Details

I. General information

NPI: 1902740624
Provider Name (Legal Business Name): CANDICE GILLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E GOLF RD
DES PLAINES IL
60016-1234
US

IV. Provider business mailing address

1136 ONTARIO ST APT 1B
OAK PARK IL
60302-1958
US

V. Phone/Fax

Practice location:
  • Phone: 847-635-1600
  • Fax:
Mailing address:
  • Phone: 917-971-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: