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General NPI Number Information
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NPI Number | 1770884314
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Entity Type | Organization
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Legal Business Name | GJM CONSULTANT SERVICES PC
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Dates
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Enumeration Date | 11/13/2010
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Last Update Date | 11/20/2013
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Provider Practice Location Address
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Address Line | 400 W. 76TH STREET SUITE 202
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City | CHICAGO
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State | IL
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Zip | 60620
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Country | US
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Telephone | 773-488-2323
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Fax | 773-488-2345
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Provider Business Mailing Address
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Address Line | 400 W. 76TH STREET SUITE 202
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City | CHICAGO
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State | IL
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Zip | 60620
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Country | US
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Telephone | 773-488-2323
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Fax | 773-488-2345
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. GWENDOLYN JEAN MAXIE-BROWN
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Credential | ED.D., SLP
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Telephone | 708-769-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | IL
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