Provider Demographics
NPI:1760679047
Name:CLEMENS, GRETCHEN KATHRYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:KATHRYN
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 S MILWAUKEE AVE
Mailing Address - Street 2:SUITE #407
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3764
Mailing Address - Country:US
Mailing Address - Phone:224-207-8118
Mailing Address - Fax:224-218-3098
Practice Address - Street 1:1580 S MILWAUKEE AVE
Practice Address - Street 2:SUITE #407
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3764
Practice Address - Country:US
Practice Address - Phone:224-207-8118
Practice Address - Fax:224-218-3098
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490075721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical