Healthcare Provider Details

I. General information

NPI: 1891606075
Provider Name (Legal Business Name): MR. JEFFREY WILLIAM GATES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 SKOKIE BLVD STE 215
NORTHBROOK IL
60062-4033
US

IV. Provider business mailing address

910 SKOKIE BLVD STE 215
NORTHBROOK IL
60062-4033
US

V. Phone/Fax

Practice location:
  • Phone: 847-480-0300
  • Fax:
Mailing address:
  • Phone: 847-480-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number50.119200
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: