Provider Demographics
NPI:1508022633
Name:DOBKOWSKI, GERARD (MA LPC CPT)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:
Last Name:DOBKOWSKI
Suffix:
Gender:M
Credentials:MA LPC CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 LACEY AVE
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1366
Mailing Address - Country:US
Mailing Address - Phone:630-963-6755
Mailing Address - Fax:
Practice Address - Street 1:799 ROOSEVELT RD. BLDG. 4
Practice Address - Street 2:SUITE 316
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137
Practice Address - Country:US
Practice Address - Phone:630-688-7031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.003750101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional