Provider Demographics
NPI:1487723490
Name:GEMMELL, VIRGINIA ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ANN
Last Name:GEMMELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3904
Mailing Address - Country:US
Mailing Address - Phone:630-584-5338
Mailing Address - Fax:
Practice Address - Street 1:1000 W LAKE ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2086
Practice Address - Country:US
Practice Address - Phone:630-715-6390
Practice Address - Fax:630-458-0176
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical