MEDICARE: GAYL MONTO LSW, CADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	150015436	IL

General Provider Information

NPI Number	:	1881083954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYL MONTO LSW, CADC

Provider Business Mailing Address
First Line	:	3633 W LAKE AVE STE 305
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5803
Country	:	US
Telephone Number	:	847-657-7337
Fax Number	:	847-657-7331

Provider Business Practice Location Address
First Line	:	3633 W LAKE AVE STE 305
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5803
Country	:	US
Telephone Number	:	847-657-7337
Fax Number	:	847-657-7331

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

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	01/13/2015

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