Renita Shores-Gaston

NPI #1518421577 in Rockford, Illinois

Provider Information

NPI Number: 1518421577
Entity Type: Organization
Organization Name: Renita Shores-Gaston
Primary Specialty: Social Worker - Clinical
Enumeration Date: Jan 24, 2019
Last Updated: Sep 26, 2022

Practice Location

Address: 5844 ELAINE DR STE 101
City: Rockford
State: Illinois
ZIP Code: 61108-2494
Phone: (815) 373-3027

Authorized Official

Name: RENITA SHORES-GASTON
Title: OWNER
Phone: (815) 543-2789

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X	Primary

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