Provider Demographics
NPI:1619347713
Name:PENDLEY, GABRIELLE BRADY (LCSW)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:BRADY
Last Name:PENDLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3741
Mailing Address - Country:US
Mailing Address - Phone:312-572-4925
Mailing Address - Fax:
Practice Address - Street 1:1010 LAKE ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1147
Practice Address - Country:US
Practice Address - Phone:312-809-0298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0179941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical