Provider Demographics
NPI:1093328486
Name:GEBHARD, MARLENA CHRISTINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARLENA
Middle Name:CHRISTINE
Last Name:GEBHARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5145 N CLARK ST # 1099
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2829
Mailing Address - Country:US
Mailing Address - Phone:615-521-1071
Mailing Address - Fax:
Practice Address - Street 1:5145 N CLARK ST # 1099
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2829
Practice Address - Country:US
Practice Address - Phone:615-521-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0255321041C0700X
IL150.104560104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker