Healthcare Provider Details

I. General information

NPI: 1538262191
Provider Name (Legal Business Name): GAYLE VINCENT CALLAHAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAYLE GENEVIEVE VINCENT PHD

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 N BIG HOLLOW RD
PEORIA IL
61615-2451
US

IV. Provider business mailing address

6615 N BIG HOLLOW RD
PEORIA IL
61615-2451
US

V. Phone/Fax

Practice location:
  • Phone: 309-692-6622
  • Fax: 309-692-6952
Mailing address:
  • Phone: 309-692-6622
  • Fax: 309-692-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: