Provider Demographics
NPI:1609548270
Name:BONDS CARPENTER, GAIL D
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:D
Last Name:BONDS CARPENTER
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 1:741 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-2015
Mailing Address - Country:US
Mailing Address - Phone:708-969-7017
Mailing Address - Fax:
Practice Address - Street 1:741 CEDAR LN
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-2015
Practice Address - Country:US
Practice Address - Phone:708-969-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL105.104636104100000X
IL150104636104100000X
IL104100000X
IL150.104636104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker