Most Relevant Information
Provider Data
| NPI Number: | 1003452111 |
| Provider Name: | NEVADAGABRIELLE BENNETT LPC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 178015414 |
Most Important Dates
| Enumeration Date: | 11/24/2019 |
| Last Updated: | 11/24/2019 |
Provider Practice Location
5117 MAIN ST STE 15
DOWNERS GROVE
IL
605154654
Practice Location Phone/Fax
| Phone: | 6305061491 |
| Fax: |
Provider Mailing Location
PO BOX 5050
RIVER FOREST
IL
603055050
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |