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General NPI Number Information
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NPI Number | 1972543668
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Entity Type | Individual
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Provider Name | GARY PAUL WAKEFIELD MSW LCSW BCD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1497 NORTH LAFOX
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-1227
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Country | US
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Telephone | 847-697-4747
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Fax | 847-697-4717
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Provider Business Mailing Address
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Address Line | 1497 NORTH LAFOX
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-1227
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Country | US
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Telephone | 847-697-4747
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Fax | 847-697-4717
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | IL
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