Healthcare Provider Details

I. General information

NPI: 1306239520
Provider Name (Legal Business Name): MICHELLE GONZALES LCSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MICHELLE WALKER

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34121 N US HIGHWAY 45 STE 101
GRAYSLAKE IL
60030-1777
US

IV. Provider business mailing address

34121 N US HIGHWAY 45 STE 101
GRAYSLAKE IL
60030-1777
US

V. Phone/Fax

Practice location:
  • Phone: 847-232-3503
  • Fax:
Mailing address:
  • Phone: 847-232-3503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number32167
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: