Provider Demographics
NPI:1356765986
Name:GILLETT, REBECCA (LCSW, MS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GILLETT
Suffix:
Gender:F
Credentials:LCSW, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 W BELMONT AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4796
Mailing Address - Country:US
Mailing Address - Phone:847-528-9393
Mailing Address - Fax:
Practice Address - Street 1:451 N LA SALLE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-4510
Practice Address - Country:US
Practice Address - Phone:312-460-3861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0164641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical