Healthcare Provider Details

I. General information

NPI: 1306502729
Provider Name (Legal Business Name): LAUREN E GABOREK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 IL-53 N
ELK GROVE VILLAGE IL
60007
US

IV. Provider business mailing address

4939 W FULLERTON AVE
CHICAGO IL
60639-2505
US

V. Phone/Fax

Practice location:
  • Phone: 847-524-8800
  • Fax:
Mailing address:
  • Phone: 312-970-1399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149027253
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: