Provider Demographics
NPI:1558621987
Name:GERTZ, MICHELLE AMY (MAED)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:AMY
Last Name:GERTZ
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 W TOUHY AVE
Mailing Address - Street 2:G
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645
Mailing Address - Country:US
Mailing Address - Phone:773-764-7095
Mailing Address - Fax:
Practice Address - Street 1:2844 W TOUHY AVE
Practice Address - Street 2:G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-2966
Practice Address - Country:US
Practice Address - Phone:773-764-7095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst