Provider Demographics
NPI:1811148216
Name:TAUCHEN, GAYLE SUSAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:SUSAN
Last Name:TAUCHEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:GAYLE
Other - Middle Name:SUSAN
Other - Last Name:WISNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:279 S MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3008
Mailing Address - Country:US
Mailing Address - Phone:630-674-9753
Mailing Address - Fax:
Practice Address - Street 1:279 S MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-674-9753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0122471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical