Provider Demographics
NPI:1689258105
Name:GAWEL, CHRISTINE MARY
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARY
Last Name:GAWEL
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 1:6817 W 110TH ST
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-1422
Mailing Address - Country:US
Mailing Address - Phone:630-452-9624
Mailing Address - Fax:
Practice Address - Street 1:8259 LAVERGNE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-2794
Practice Address - Country:US
Practice Address - Phone:708-499-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005045261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech