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General NPI Number Information
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NPI Number | 1205452596
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Entity Type | Individual
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Provider Name | JENNIFER M GORMAN MS, SSP
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Gender | Female
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 6509 POWELL ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-2721
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Country | US
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Telephone | 630-719-5850
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Fax |
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Provider Business Mailing Address
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Address Line | 9162 GREENCASTLE LN
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City | ORLAND PARK
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State | IL
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Zip | 60462-3235
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Country | US
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Telephone | 217-778-0136
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 2009737
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License Number State | IL
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