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NPI Code Detail

MEDICARE: LISA GACKI LSW

MEDICARE: LISA GACKI LSW
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1225695661
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA GACKI LSW
Provider Business Mailing Address
First Line : 1101 31ST ST STE 105
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-5535
Country : US
Telephone Number : 630-206-0272
Fax Number :
Provider Business Practice Location Address
First Line : 1101 31ST ST STE 105
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-5535
Country : US
Telephone Number : 630-206-0272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2019
Last Update Date : 04/26/2022

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Directions to “ LISA GACKI LSW” Practice Location

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