MEDICARE: MS. GAYE C. VANDIGGELEN L.M.F.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	166-000470	IL

General Provider Information

NPI Number	:	1013091214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GAYE C. VANDIGGELEN L.M.F.T.

Provider Business Mailing Address
First Line	:	1121 WASHINGTON AVE
Second Line	:
City	:	WAUCONDA
State	:	IL
Zip	:	60084-1370
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 NORTH COURT
Second Line	:	SUITE 380
City	:	PALATINE
State	:	IL
Zip	:	60067-8131
Country	:	US
Telephone Number	:	847-327-1406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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