Provider Demographics
NPI:1114040649
Name:GERNDT, NICOLE H (LCPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:H
Last Name:GERNDT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-2013
Mailing Address - Country:US
Mailing Address - Phone:773-332-9637
Mailing Address - Fax:186-620-6262
Practice Address - Street 1:6601 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1005
Practice Address - Country:US
Practice Address - Phone:773-332-9637
Practice Address - Fax:186-620-6262
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional