Active NPI
Michelle Gaede, LCPC
- Professional Counselor
- Peoria, IL
National Provider Identifier
1609374412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180011374
- Practice address
- 2610 W Richwoods Blvd
Peoria, IL 61604-7112 - Phone
- (309) 323-6600
- NPI assigned
- Jan 26, 2018
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180011374 | IL | Primary |
Addresses
Primary practice location
2610 W Richwoods Blvd
Peoria, IL 61604-7112
Mailing address
2610 W Richwoods Blvd
Peoria, IL 61604-7112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180011374 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mental Health Specialty Group PA | Professional | Current | Accepting new patients |
Locations
332 S Michigan Ave
Chicago, IL 60604
Phone (773) 633-7479
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516924800000",
"number": "1609374412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2610 W RICHWOODS BLVD",
"city": "PEORIA",
"state": "IL",
"postal_code": "616047112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2610 W RICHWOODS BLVD",
"city": "PEORIA",
"state": "IL",
"postal_code": "616047112",
"telephone_number": "309-323-6600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAEDE",
"first_name": "MICHELLE",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-26",
"last_updated": "2018-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180011374",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.