Provider Demographics
NPI:1790098572
Name:GORDON, ALLISON L (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:L
Last Name:GORDON
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 1:633 SKOKIE BLVD
Mailing Address - Street 2:260
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2858
Mailing Address - Country:US
Mailing Address - Phone:847-480-0300
Mailing Address - Fax:847-291-0576
Practice Address - Street 1:633 SKOKIE BLVD
Practice Address - Street 2:260
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2858
Practice Address - Country:US
Practice Address - Phone:847-480-0300
Practice Address - Fax:847-291-0576
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490083391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical