| Gateway Psychological Services, Ltd | |
|
412 N Lake St Suite 204 Aurora IL 60506-4106 | |
| (630) 896-2337 | |
| (630) 896-3515 |
| Full Name | Gateway Psychological Services, Ltd |
|---|---|
| Speciality | Psychologist |
| Location | 412 N Lake St, Aurora, Illinois |
| Authorized Official Name and Position | Charlotte Ann Dillon (OWNER) |
| Authorized Official Contact | 6308962337 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gateway Psychological Services, Ltd 412 N Lake St Suite 204 Aurora IL 60506-4106 Ph: (630) 896-2337 | Gateway Psychological Services, Ltd 412 N Lake St Suite 204 Aurora IL 60506-4106 Ph: (630) 896-2337 |
| NPI Number | 1619163268 |
|---|---|
| Provider Enumeration Date | 09/18/2007 |
| Last Update Date | 10/19/2012 |
| Medicare PECOS PAC ID | 7810146990 |
|---|---|
| Medicare Enrollment ID | O20121004000616 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619163268 | NPI | - | NPPES |
| 4515275 | Other | IL | BC BS OF ILLINOIS |
| 4572030 | Other | IL | BC BS OF ILLINOIS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071004310 (Illinois) | Primary |
| Provider Name | Charlotte A Dillon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326114562 PECOS PAC ID: 3476742693 Enrollment ID: I20110104000605 |
| Provider Name | Marissa J Happ |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457988693 PECOS PAC ID: 4082045661 Enrollment ID: I20200514002463 |
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