Basic Information
| Provider Information | |||||||||
| NPI: | 1841359957 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWEET | ||||||||
| FirstName: | GORDON | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | L.C.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1502 W PRATT BLVD | ||||||||
| Address2: | #1 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606264219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735085313 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8020 W 87TH ST | ||||||||
| Address2: | |||||||||
| City: | HICKORY HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604571189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087414500 | ||||||||
| FaxNumber: | 7087414501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.