| Doctor Name: | MRS. GLORIA E PASSALACQUA |
| NPI Number: | 1023155744 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA LCPC |
| License Number: | 180-002124 |
| Business Practice Address: | 6551 W North Ave Oak Park, IL - 60302 |
| Business Phone Number: | 8476874848 |
| Business Fax Number: | 8478530069 |
| Mailing Address: | 500 Koerper Ct, WILMETTE |
| State: | IL |
| Postal Code: | 60091 |
| Phone Number: | 8478530069 |
| Fax Number: | 8478530069 |
| NPI Enumeration Date: | 01/31/2007 |
| NPI Last Update Date: | 08/02/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 180-002124 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |