Provider Demographics
NPI:1790927770
Name:MONICA K. FERKIN, LLC
Entity Type:Organization
Organization Name:MONICA K. FERKIN, LLC
Other - Org Name:MONICA K. FERKIN
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FERKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC, CEAP
Authorized Official - Phone:847-770-7202
Mailing Address - Street 1:7285 CLEM DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5194
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 NATIONS DR
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9168
Practice Address - Country:US
Practice Address - Phone:224-501-5102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0000231041C0700X
WI6617-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty