Provider Demographics
NPI:1649755216
Name:GRADLE AND ASSOCIATES LLC
Entity Type:Organization
Organization Name:GRADLE AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GRADLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-218-5002
Mailing Address - Street 1:110 S GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2806
Mailing Address - Country:US
Mailing Address - Phone:708-218-5002
Mailing Address - Fax:
Practice Address - Street 1:5612 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-5514
Practice Address - Country:US
Practice Address - Phone:708-218-5002
Practice Address - Fax:773-498-3659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-30
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty