Provider Demographics
NPI:1033428438
Name:AMES, GWEN P (LCSW)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:P
Last Name:AMES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E IRVING PARK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2322
Mailing Address - Country:US
Mailing Address - Phone:630-229-9940
Mailing Address - Fax:
Practice Address - Street 1:701 E IRVING PARK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2322
Practice Address - Country:US
Practice Address - Phone:630-229-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-02
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490143701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical