| Doctor Name: | JESSICA GEBBINK |
| NPI Number: | 1063881266 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 149013128 |
| Business Practice Address: | 89 Cedar Ave Lake Villa, IL - 600468411 |
| Business Phone Number: | 8472657300 |
| Business Fax Number: | 8472657301 |
| Mailing Address: | 89 Cedar Ave, Po Box 764 LAKE VILLA |
| State: | IL |
| Postal Code: | 600468411 |
| Phone Number: | 8472657300 |
| Fax Number: | 8472657301 |
| NPI Enumeration Date: | 09/17/2015 |
| NPI Last Update Date: | 09/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 149013128 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |