| Northwestern Medicine Ben Gordon Center | |
|
12 Health Services Dr Dekalb IL 60115 | |
| (815) 756-4875 | |
| Not Available |
| Full Name | Northwestern Medicine Ben Gordon Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 12 Health Services Dr, Dekalb, Illinois |
| Authorized Official Name and Position | Bettyjo Fortune (FINANCIAL ASSESSOR) |
| Authorized Official Contact | 8157564875 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwestern Medicine Ben Gordon Center Po Box 1109 Dekalb IL 60115-7109 Ph: (815) 756-4875 | Northwestern Medicine Ben Gordon Center 12 Health Services Dr Dekalb IL 60115 Ph: (815) 756-4875 |
| NPI Number | 1255703450 |
|---|---|
| Provider Enumeration Date | 10/27/2015 |
| Last Update Date | 07/23/2018 |
| Medicare PECOS PAC ID | 9436451655 |
|---|---|
| Medicare Enrollment ID | O20160111000872 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255703450 | NPI | - | NPPES |
| 1255703450 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Samar Mahmood |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669545943 PECOS PAC ID: 8325060676 Enrollment ID: I20051229000642 |
| Provider Name | Lorna K Mackeben |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053545962 PECOS PAC ID: 4688725484 Enrollment ID: I20090707000317 |
| Provider Name | Iram M Qazi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457517708 PECOS PAC ID: 9234272493 Enrollment ID: I20100210000390 |
| Provider Name | Katherine L Lueken |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407183155 PECOS PAC ID: 4284762691 Enrollment ID: I20100505000752 |
| Provider Name | Collette A Klein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659639862 PECOS PAC ID: 9234385758 Enrollment ID: I20120815000501 |
| Provider Name | Deepa R Nadimpalli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568658714 PECOS PAC ID: 1456506385 Enrollment ID: I20130227000035 |
| Provider Name | Sabrina Nicholson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780929430 PECOS PAC ID: 4082845243 Enrollment ID: I20140401001541 |
| Provider Name | Kassandra M Jedliola |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427322130 PECOS PAC ID: 5890011563 Enrollment ID: I20150225000461 |
| Provider Name | Marissa M Kirch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639562101 PECOS PAC ID: 2264750017 Enrollment ID: I20150408000562 |
| Provider Name | Raya M Newman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659755965 PECOS PAC ID: 7012229586 Enrollment ID: I20150713000606 |
| Provider Name | Nicole Ashley Jazo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619223591 PECOS PAC ID: 8022358167 Enrollment ID: I20190327001855 |
| Provider Name | Darlene Seilheimer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942707047 PECOS PAC ID: 7113352576 Enrollment ID: I20200114001260 |
| Provider Name | Ashley Marie Maki |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386203511 PECOS PAC ID: 3173931748 Enrollment ID: I20210420001430 |
| Provider Name | Leslie Anne Hendrickson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730845017 PECOS PAC ID: 1153711833 Enrollment ID: I20211213001320 |
| Provider Name | Jasmine Alexis Sronkoski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376164822 PECOS PAC ID: 3870988140 Enrollment ID: I20220323002019 |
| Provider Name | Debra C Farnsworth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336733724 PECOS PAC ID: 2961888995 Enrollment ID: I20220928003651 |
| Provider Name | Cheryl Ann Beutell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821360520 PECOS PAC ID: 7113396151 Enrollment ID: I20221213002626 |
| Provider Name | Rhyann Brianna Willey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215543111 PECOS PAC ID: 1759747942 Enrollment ID: I20230512001879 |
| Provider Name | Kathryn Higgins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477159028 PECOS PAC ID: 2365809647 Enrollment ID: I20230531002820 |
| Provider Name | Layne Kirch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790133056 PECOS PAC ID: 5799143020 Enrollment ID: I20230620000912 |
| Provider Name | Victoria Mourning |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942613104 PECOS PAC ID: 6103273925 Enrollment ID: I20231229000726 |
| Provider Name | Christine Alexandra Maxwell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003368739 PECOS PAC ID: 1850748542 Enrollment ID: I20240208002116 |
| Provider Name | Sabhia Sims |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114481421 PECOS PAC ID: 6305294638 Enrollment ID: I20240212001578 |
| Provider Name | Serena Anne Frost |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336586056 PECOS PAC ID: 9830532399 Enrollment ID: I20240212002855 |
| Provider Name | Sara Leduc |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437802055 PECOS PAC ID: 4789031402 Enrollment ID: I20240214000279 |
| Provider Name | Marta Jarka |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750840237 PECOS PAC ID: 0648627612 Enrollment ID: I20240214000542 |
| Provider Name | Pagel Edward Palmer |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1043931231 PECOS PAC ID: 9335582444 Enrollment ID: I20240220003173 |
| Provider Name | Courtney Lea Mason |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992076442 PECOS PAC ID: 6103273024 Enrollment ID: I20240222000379 |
| Provider Name | Emily Anne Dienst |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720352487 PECOS PAC ID: 2860835980 Enrollment ID: I20240228003363 |
| Provider Name | Haley Herrmann |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316572035 PECOS PAC ID: 1254788326 Enrollment ID: I20240319000910 |
| Provider Name | Megan Dixon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144983131 PECOS PAC ID: 5496197683 Enrollment ID: I20240520001436 |
Dr Moana, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 401 E Hillcrest Dr, Dekalb, IL 60115 Phone: 773-656-2738 | |
Thrive Behavioral Connections Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1005 W Lincoln Hwy Unit A11, Dekalb, IL 60115 Phone: 815-315-7852 | |
Dekalb County Youth Services Bureau Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 330 Grove St, Dekalb, IL 60115 Phone: 815-748-2010 Fax: 815-748-2019 | |
Pyramid Behavioral Health Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 8 Evergreen Cir, Dekalb, IL 60115 Phone: 773-217-4907 | |
Illinois Neurocare Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1 Kish Hospital Dr, Dekalb, IL 60115 Phone: 815-756-1521 | |
Family Center Of Niu Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 146 Wirtz Hall, Dekalb, IL 60115 Phone: 815-753-1684 Fax: 815-753-1627 | |
Association For Individual Development Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 507 E Taylor St, Dekalb, IL 60115 Phone: 630-966-4475 |