MEDICARE: JACOB W GILMAN

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	149027864	IL

General Provider Information

NPI Number	:	1982495123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB W GILMAN

Provider Business Mailing Address
First Line	:	6469 SANDY BOTTOM DR
Second Line	:
City	:	FULTON
State	:	IL
Zip	:	61252-9413
Country	:	US
Telephone Number	:	815-535-1393
Fax Number	:	815-535-1393

Provider Business Practice Location Address
First Line	:	7300 W COLLEGE DR STE 102
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1181
Country	:	US
Telephone Number	:	815-535-1393
Fax Number	:

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

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	05/15/2025

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