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General NPI Number Information
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NPI Number | 1194262063
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Entity Type | Individual
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Provider Name | ELIZABETH GADDIS LCPC
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Gender | Female
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 236 S WASHINGTON ST STE 212
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City | NAPERVILLE
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State | IL
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Zip | 60540-6698
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Country | US
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Telephone | 630-243-5385
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Fax |
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Provider Business Mailing Address
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Address Line | 222 DORSET AVE
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City | OSWEGO
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State | IL
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Zip | 60543-6056
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Country | US
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Telephone | 630-701-8843
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180012677
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178012484
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License Number State | IL
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