Provider Demographics
NPI:1194262063
Name:GADDIS, ELIZABETH (LCPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GADDIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 DORSET AVE
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-6056
Mailing Address - Country:US
Mailing Address - Phone:630-701-8843
Mailing Address - Fax:
Practice Address - Street 1:236 S WASHINGTON ST STE 212
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6698
Practice Address - Country:US
Practice Address - Phone:630-243-5385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IL180012677101YP2500X
IL178012484101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)