Healthcare Provider Details

I. General information

NPI: 1811651292
Provider Name (Legal Business Name): ANDREA SUE GILMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA SUE GILMAN-VALLEJO MSW

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 3RD ST
MOLINE IL
61265-6106
US

IV. Provider business mailing address

2404 62ND AVE W
MILAN IL
61264-2054
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-2031
  • Fax:
Mailing address:
  • Phone: 309-737-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number287969
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: