Provider Demographics
NPI:1265605893
Name:ROSS- GWIN, BRIGITTE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:BRIGITTE
Middle Name:ANN
Last Name:ROSS- GWIN
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:C/O 4540 HUNT CLUB DR
Mailing Address - Street 2:APT. 1-D
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197
Mailing Address - Country:US
Mailing Address - Phone:630-886-0732
Mailing Address - Fax:
Practice Address - Street 1:13252 SANTA FE RD
Practice Address - Street 2:APT. 102
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446
Practice Address - Country:US
Practice Address - Phone:815-293-6065
Practice Address - Fax:815-293-6065
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0129431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical