Healthcare Provider Details

I. General information

NPI: 1497499628
Provider Name (Legal Business Name): GABRIELLE MEYER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ROOSEVELT RD
GLEN ELLYN IL
60137-6031
US

IV. Provider business mailing address

1200 ROOSEVELT RD
GLEN ELLYN IL
60137-6031
US

V. Phone/Fax

Practice location:
  • Phone: 708-228-7223
  • Fax:
Mailing address:
  • Phone: 708-228-7223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149014818
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: