Provider Demographics
NPI:1104919646
Name:GILL, ALAN R (LCSW,SAP,MSW)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:R
Last Name:GILL
Suffix:
Gender:M
Credentials:LCSW,SAP,MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12255 S 80TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-923-7878
Mailing Address - Fax:708-923-7888
Practice Address - Street 1:12255 S 80TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-923-7878
Practice Address - Fax:708-923-7888
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149002385104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149002385Medicaid
IL363827229OtherWPS
IL800011385OtherRR MEDICARE
IL266167OtherVALUE BEHAVIORAL
IL219043OtherMAGELLAN
IL0991516762OtherBCBS
IL800011385OtherRR MEDICARE
IL149002385Medicaid