Active NPI
Sally Sue Wilson Gamble, DT
- Developmental Therapist
- Countryside, IL
National Provider Identifier
1376687251
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 9649 W 55TH St
Countryside, IL 60525 - Phone
- (708) 352-3580
- Fax
- (708) 352-2715
- NPI assigned
- Feb 16, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | Primary |
Addresses
Primary practice location
9649 W 55TH St
Countryside, IL 60525
Mailing address
614 S Wenonah Ave
Oak Park, IL 60304
Phone (708) 386-6818
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376687251",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "614 S WENONAH AVE",
"city": "OAK PARK",
"state": "IL",
"postal_code": "60304",
"telephone_number": "708-386-6818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9649 W 55TH ST",
"city": "COUNTRYSIDE",
"state": "IL",
"postal_code": "60525",
"telephone_number": "708-352-3580",
"fax_number": "708-352-2715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON GAMBLE",
"first_name": "SALLY",
"middle_name": "SUE",
"name_prefix": "Ms.",
"credential": "DT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Countryside, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.