Provider Demographics
NPI:1811651292
Name:GILMAN, ANDREA SUE (MSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:SUE
Last Name:GILMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:SUE
Other - Last Name:GILMAN-VALLEJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2404 62ND AVE W
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-2054
Mailing Address - Country:US
Mailing Address - Phone:309-737-6863
Mailing Address - Fax:
Practice Address - Street 1:4600 3RD ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6106
Practice Address - Country:US
Practice Address - Phone:309-779-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2879691041S0200X
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool