Provider Demographics
NPI:1598831372
Name:SIMMONS GIBLIN, DENISE KAYE (DMIN,MS,MSW)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:KAYE
Last Name:SIMMONS GIBLIN
Suffix:
Gender:F
Credentials:DMIN,MS,MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 KEDZIE ST
Mailing Address - Street 2:G
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2478
Mailing Address - Country:US
Mailing Address - Phone:847-347-0753
Mailing Address - Fax:
Practice Address - Street 1:321 KEDZIE ST
Practice Address - Street 2:G
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2478
Practice Address - Country:US
Practice Address - Phone:847-347-0753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical