Provider Demographics
NPI:1053992362
Name:GLISPIE-GOGINS, CHLOE SHAVONNE (LCSW)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:SHAVONNE
Last Name:GLISPIE-GOGINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHLOE
Other - Middle Name:SHAVONNE
Other - Last Name:GLISPIE-GOGINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2501 CHATHAM RD # 5051
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4188
Mailing Address - Country:US
Mailing Address - Phone:773-490-6523
Mailing Address - Fax:
Practice Address - Street 1:2501 CHATHAM RD # 5051
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4188
Practice Address - Country:US
Practice Address - Phone:773-916-6513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0231041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty