Provider Demographics
NPI:1306398797
Name:GARDNER, CHRISTI L (LCSW, CADC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTI
Middle Name:L
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1749
Mailing Address - Country:US
Mailing Address - Phone:773-793-5559
Mailing Address - Fax:
Practice Address - Street 1:6033 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3003
Practice Address - Country:US
Practice Address - Phone:773-793-5559
Practice Address - Fax:877-505-2823
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL31900101YA0400X
IL1490184271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)