Provider Demographics
NPI:1174894695
Name:GINSKI, GWEN E (LCSW)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:E
Last Name:GINSKI
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 1:13002 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-1460
Mailing Address - Country:US
Mailing Address - Phone:815-999-5684
Mailing Address - Fax:
Practice Address - Street 1:23908 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2122
Practice Address - Country:US
Practice Address - Phone:815-683-8700
Practice Address - Fax:815-384-1061
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490148681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400117960Medicare Oscar/Certification