Provider Demographics
NPI:1518724988
Name:GREMP, ALEXANDRA KERRI
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KERRI
Last Name:GREMP
Suffix:
Gender:F
Credentials:
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 RICHMOND ST APT N1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1992
Mailing Address - Country:US
Mailing Address - Phone:708-692-2704
Mailing Address - Fax:
Practice Address - Street 1:929 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4408
Practice Address - Country:US
Practice Address - Phone:312-530-0323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health