Provider Demographics
NPI:1770654816
Name:GARDNER PSYCHOLOGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:GARDNER PSYCHOLOGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KENNEDY
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-372-3322
Mailing Address - Street 1:203 N WABASH AVE
Mailing Address - Street 2:SUITE 1805
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-2406
Mailing Address - Country:US
Mailing Address - Phone:312-372-3322
Mailing Address - Fax:
Practice Address - Street 1:203 N WABASH AVE
Practice Address - Street 2:SUITE 1805
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-2406
Practice Address - Country:US
Practice Address - Phone:312-372-3322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty