Active NPI
Gloria E Passalacqua, MA LCPC
- Professional Counselor
- Oak Park, IL
National Provider Identifier
1023155744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180-002124
- Practice address
- 6551 W North Ave
Oak Park, IL 60302 - Phone
- (847) 687-4848
- Fax
- (847) 853-0069
- NPI assigned
- Jan 31, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180-002124 | IL | Primary |
Addresses
Primary practice location
6551 W North Ave
Oak Park, IL 60302
Mailing address
500 Koerper CT
Wilmette, IL 60091
Phone (847) 853-0069
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180-002124 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312243200000",
"number": "1023155744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 KOERPER CT",
"city": "WILMETTE",
"state": "IL",
"postal_code": "60091",
"telephone_number": "847-853-0069",
"fax_number": "847-853-0069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6551 W NORTH AVE",
"city": "OAK PARK",
"state": "IL",
"postal_code": "60302",
"telephone_number": "847-687-4848",
"fax_number": "847-853-0069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PASSALACQUA",
"first_name": "GLORIA",
"middle_name": "E",
"name_prefix": "Mrs.",
"credential": "MA LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2011-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180-002124",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.