Provider Demographics
NPI:1124790548
Name:WINTERBOTTOM, GARILYNN (PSYD)
Entity type:Individual
Prefix:
First Name:GARILYNN
Middle Name:
Last Name:WINTERBOTTOM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 PRAIRIE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-9033
Mailing Address - Country:US
Mailing Address - Phone:181-551-4041
Mailing Address - Fax:
Practice Address - Street 1:604 PRAIRIE VIEW DR
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-9033
Practice Address - Country:US
Practice Address - Phone:181-551-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health