Healthcare Provider Details

I. General information

NPI: 1285487389
Provider Name (Legal Business Name): GWYN KELLY POUNDS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13550 S ROUTE 30 STE 204B
PLAINFIELD IL
60544-5688
US

IV. Provider business mailing address

279 S OAK CREEK LN
ROMEOVILLE IL
60446-5335
US

V. Phone/Fax

Practice location:
  • Phone: 630-465-0671
  • Fax:
Mailing address:
  • Phone: 630-914-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149026636
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: