Provider Demographics
NPI:1023869039
Name:VELCICH, GINO
Entity type:Individual
Prefix:
First Name:GINO
Middle Name:
Last Name:VELCICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 CARGILL DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6609
Mailing Address - Country:US
Mailing Address - Phone:773-580-0175
Mailing Address - Fax:
Practice Address - Street 1:950 SKOKIE BLVD STE 208
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4017
Practice Address - Country:US
Practice Address - Phone:773-592-7367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional