Provider Demographics
NPI:1376645630
Name:GERARD, DIANNE (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:GERARD
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 ASCOT LN
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-8040
Mailing Address - Country:US
Mailing Address - Phone:847-334-8445
Mailing Address - Fax:
Practice Address - Street 1:1000 HART RD STE 130
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2668
Practice Address - Country:US
Practice Address - Phone:847-334-8445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178-003661101YP2500X
IL180006512101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633897OtherBCBS GRP PROVIDER NUMBER
IL32-0084889OtherGROUP TAX ID NUMBER