Healthcare Provider Details

I. General information

NPI: 1285987511
Provider Name (Legal Business Name): GAYLE M PAPE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 S WEST ST
WHEATON IL
60187-5038
US

IV. Provider business mailing address

618 S WEST ST
WHEATON IL
60187-5038
US

V. Phone/Fax

Practice location:
  • Phone: 630-668-8710
  • Fax: 630-668-8779
Mailing address:
  • Phone: 630-668-8710
  • Fax: 630-668-8779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149015310
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: