Provider Demographics
NPI:1619163268
Name:GATEWAY PSYCHOLOGICAL SERVICES, LTD
Entity Type:Organization
Organization Name:GATEWAY PSYCHOLOGICAL SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-896-2337
Mailing Address - Street 1:412 N LAKE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4106
Mailing Address - Country:US
Mailing Address - Phone:630-896-2337
Mailing Address - Fax:630-896-3515
Practice Address - Street 1:412 N LAKE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4106
Practice Address - Country:US
Practice Address - Phone:630-896-2337
Practice Address - Fax:630-896-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004310103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4515275OtherBC BS OF ILLINOIS
IL4572030OtherBC BS OF ILLINOIS
IL4572030OtherBC BS OF ILLINOIS