Healthcare Provider Details

I. General information

NPI: 1588982631
Provider Name (Legal Business Name): ALEXANDRIA ANNE GOHLA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 REDSTART RD
NAPERVILLE IL
60565-2335
US

IV. Provider business mailing address

88 REDSTART RD
NAPERVILLE IL
60565-2335
US

V. Phone/Fax

Practice location:
  • Phone: 630-479-3646
  • Fax:
Mailing address:
  • Phone: 630-479-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149023584
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: