Healthcare Provider Details

I. General information

NPI: 1699679266
Provider Name (Legal Business Name): MARCELLA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOHN MIDDLETON ELEMENTARY SCHOOL 8300 ST LOUIS AVE
SKOKIE IL
60076
US

IV. Provider business mailing address

JOHN MIDDLETON ELEMENTARY SCHOOL 8300 ST LOUIS AVE
SKOKIE IL
60076
US

V. Phone/Fax

Practice location:
  • Phone: 847-673-1222
  • Fax:
Mailing address:
  • Phone: 847-673-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2679814
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: