NPI 1003211426

Jennifer Gibson, PSYD

Organisation Clinical Psychologist Chicago, IL

Practice location

Address: 2650 W Montrose Ave Suite 200, Chicago, IL 60618-1560
Phone: (872) 205-6110
Mailing address: 4334 N Bell Ave, Chicago, IL 60618-1610

Authorised official

Name: Jennifer Gibson
Title: Licensed Clinical Psychologist
Phone: (312) 316-5551

Registered specialties

Clinical Psychologist Primary

Behavioral Health & Social Service Providers Taxonomy 103TC0700X Licence 071007651 (IL)

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Registry record

NPI: 1003211426
Entity type: Organization
NPI issued: 28 Oct 2014
Record last updated: 28 Oct 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.