Individual
MS. DIANE TOBY GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
1017 BELLEFORTE AVE, OAK PARK, IL 60302-1303
(708) 848-2983
(708) 848-9922
Mailing address
1017 BELLEFORTE AVE, OAK PARK, IL 60302-1303
(708) 848-2983
(708) 848-9922
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1671023
BLUE CROSS
IL
Enumeration date
08/22/2006
Last updated
07/08/2007
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