Provider Demographics
NPI:1396231684
Name:GILDART, TOYA M
Entity Type:Individual
Prefix:
First Name:TOYA
Middle Name:M
Last Name:GILDART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PILLARS
Mailing Address - Street 2:6415 STANLEY AVENUE
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402
Mailing Address - Country:US
Mailing Address - Phone:708-745-5277
Mailing Address - Fax:708-788-8535
Practice Address - Street 1:PILLARS
Practice Address - Street 2:6415 STANLEY AVENUE
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402
Practice Address - Country:US
Practice Address - Phone:708-745-5277
Practice Address - Fax:708-788-8535
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN104100000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker