Provider Demographics
NPI:1669834701
Name:GILMARTIN, JAMIE (LCPC, CADC)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:GILMARTIN
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6239 W 94TH ST
Mailing Address - Street 2:APARTMENT 1N
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2248
Mailing Address - Country:US
Mailing Address - Phone:708-574-3437
Mailing Address - Fax:
Practice Address - Street 1:7300 W COLLEGE DR
Practice Address - Street 2:# 203
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1152
Practice Address - Country:US
Practice Address - Phone:708-448-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL29773101YA0400X
IL180.00993101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)