Healthcare Provider Details

I. General information

NPI: 1629008230
Provider Name (Legal Business Name): GREGORY A DANA M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 OAK ST
WINNETKA IL
60093-2522
US

IV. Provider business mailing address

3891 DREXEL AVE
GURNEE IL
60031-2851
US

V. Phone/Fax

Practice location:
  • Phone: 847-446-6955
  • Fax: 847-446-6957
Mailing address:
  • Phone: 847-623-6396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-001461
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: