Healthcare Provider Details

I. General information

NPI: 1316668205
Provider Name (Legal Business Name): SIMONE GILLON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SKOKIE BLVD STE 255
NORTHBROOK IL
60062-4054
US

IV. Provider business mailing address

900 SKOKIE BLVD STE 255
NORTHBROOK IL
60062-4054
US

V. Phone/Fax

Practice location:
  • Phone: 312-870-0120
  • Fax: 312-819-2080
Mailing address:
  • Phone: 312-870-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150109055
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: