MEDICARE: GWENDOLYN HICKEY LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1811830029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GWENDOLYN HICKEY LLC

Provider Business Mailing Address
First Line	:	980 N MICHIGAN AVE STE 1090
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-4521
Country	:	US
Telephone Number	:	847-284-4936
Fax Number	:

Provider Business Practice Location Address
First Line	:	2835 N SHEFFIELD AVE
Second Line	:	SUITE 310
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	312-834-3704
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	GWENDOLYN HICKEY
Credential	:	LCSW
Telephone Number	:	847-284-4936

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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