Provider Demographics
NPI:1518405224
Name:GAMACHE, ANNE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:GAMACHE
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 1:2047 W COULTER ST
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 E LAKE ST
Practice Address - Street 2:SUITE 1300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5959
Practice Address - Country:US
Practice Address - Phone:312-423-5675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL32028101YA0400X
IL180.010720101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)