Provider Demographics
NPI:1316668205
Name:GILLON, SIMONE (LSW)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:GILLON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SKOKIE BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4054
Mailing Address - Country:US
Mailing Address - Phone:312-870-0120
Mailing Address - Fax:
Practice Address - Street 1:900 SKOKIE BLVD STE 255
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4054
Practice Address - Country:US
Practice Address - Phone:312-870-0120
Practice Address - Fax:312-819-2080
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1501090551041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health