Most Relevant Information
Provider Data
| NPI Number: | 1003690611 |
| Provider Name: | HAZEL MAE GORDON |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/23/2023 |
| Last Updated: | 08/23/2023 |
Provider Practice Location
1113 S MILWAUKEE AVE
LIBERTYVILLE
IL
600483758
Practice Location Phone/Fax
| Phone: | 8477480341 |
| Fax: | 8477480341 |
Provider Mailing Location
1113 S MILWAUKEE AVE
LIBERTYVILLE
IL
600483758
Provider Mailing Phone/Fax
| Phone: | 8477480341 |
| Fax: | 8477480341 |