Provider Demographics
NPI:1184653503
Name:GALLAGHER, NANCY A (MSW,LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 GREEN BAY RD
Mailing Address - Street 2:BLDG 135 RM A-50
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3048
Mailing Address - Country:US
Mailing Address - Phone:224-610-4841
Mailing Address - Fax:224-610-3938
Practice Address - Street 1:3001 GREEN BAY RD
Practice Address - Street 2:BLDG 135 RM A-50
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:224-610-4841
Practice Address - Fax:224-610-3938
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0075211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149-007521Medicare UPIN