Provider Demographics
NPI:1982844841
Name:SIMONIS-GAYED, DEBORAH JEAN (LCSW, MS EDU, MSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JEAN
Last Name:SIMONIS-GAYED
Suffix:
Gender:F
Credentials:LCSW, MS EDU, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 E BULLOCK ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:IL
Mailing Address - Zip Code:61530-1256
Mailing Address - Country:US
Mailing Address - Phone:309-750-2828
Mailing Address - Fax:309-200-0218
Practice Address - Street 1:2426 W CORNERSTONE CT
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2492
Practice Address - Country:US
Practice Address - Phone:309-750-2828
Practice Address - Fax:309-200-0218
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.005135104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker