Provider Demographics
NPI:1538236617
Name:SOBCZAK GIBSON, KATHY S (LCSW)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:S
Last Name:SOBCZAK GIBSON
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 1:508 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3649
Mailing Address - Country:US
Mailing Address - Phone:630-479-4335
Mailing Address - Fax:630-232-1471
Practice Address - Street 1:1120 RANDALL CT
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-3911
Practice Address - Country:US
Practice Address - Phone:630-232-1070
Practice Address - Fax:630-232-1471
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004600101YM0800X
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health