Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 071-007651 | IL |
Y | 103G00000X | Clinical Psychologist | 071-007651 | IL |
Y | 103TC0700X | Clinical Psychologist | 071-007651 | IL |
N | 103G00000X | Clinical Psychologist | 071007651 | IL |
N | 103TC0700X | Clinical Psychologist | 071007651 | IL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 071-007651 | IL |
N | 103TF0000X | Family Psychologist | 071-007651 | IL |
NPI | 1164544839 |
---|---|
Provider Name | Dr. Jennifer L Gibson |
First Address | Chicago, IL 60618-1610 |
Second Address | Chicago, IL 60618-1560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 13/10/2014 |