Doctor Name: | DR. DENNIS GIBSON |
NPI Number: | 1134574676 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 071-001808 |
Business Practice Address: | 124 Windsor Park Dr Carol Stream, IL - 601881986 |
Business Phone Number: | 6306683331 |
Business Fax Number: | |
Mailing Address: | 140 Windsor Park Dr, Apt E 202 CAROL STREAM |
State: | IL |
Postal Code: | 601885314 |
Phone Number: | 6306683331 |
Fax Number: | |
NPI Enumeration Date: | 05/03/2016 |
NPI Last Update Date: | 05/03/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 071-001808 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |