Individual
MRS. CAROL EVELYN GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
9443 DRAKE AVE, EVANSTON, IL 60203-1105
(847) 677-9187
(847) 677-9176
Mailing address
9443 DRAKE AVE, EVANSTON, IL 60203-1105
(847) 677-9187
(847) 677-9176
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149001473
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800006567
RAILROAD MEDICARE
IL
Enumeration date
07/13/2006
Last updated
07/25/2008
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