1669625992 NPI number — MS. JANE ANN GAITSKILL HONG L.C.S.W.

Table of content: MS. JANE ANN GAITSKILL HONG L.C.S.W. (NPI 1669625992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669625992 NPI number — MS. JANE ANN GAITSKILL HONG L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAITSKILL HONG
Provider First Name:
JANE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669625992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5823 N DRAKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60659-4403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-539-9275
Provider Business Mailing Address Fax Number:
773-539-9275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
64 OLD ORCHARD SHOPPING CTR
Provider Second Line Business Practice Location Address:
SUITE 236
Provider Business Practice Location Address City Name:
SKOKIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60077-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-409-4535
Provider Business Practice Location Address Fax Number:
773-539-9275
Provider Enumeration Date:
10/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149007730 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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