Provider Demographics
NPI:1134285158
Name:GILBERT, JOHN TODD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TODD
Last Name:GILBERT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 W. ROOSEVELT RD.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644
Mailing Address - Country:US
Mailing Address - Phone:773-413-1720
Mailing Address - Fax:773-413-1725
Practice Address - Street 1:5730 W. ROOSEVELT RD.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644
Practice Address - Country:US
Practice Address - Phone:773-413-1720
Practice Address - Fax:773-413-1725
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3713-125101YP2500X
IL071007665103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional