Provider Demographics
NPI:1952386427
Name:FRALEY, GWEN GASSMAN (MS, CGC)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:GASSMAN
Last Name:FRALEY
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 W THORNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3348
Mailing Address - Country:US
Mailing Address - Phone:773-807-1614
Mailing Address - Fax:847-733-5394
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:FETAL DIAGNOSTICS
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2864
Practice Address - Fax:847-733-5394
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS