Provider Demographics
NPI:1972793941
Name:SHUNK, GARY SAMUEL (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:SAMUEL
Last Name:SHUNK
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 N BRAINARD AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1809
Mailing Address - Country:US
Mailing Address - Phone:312-810-0011
Mailing Address - Fax:
Practice Address - Street 1:427 N BRAINARD AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE PARK
Practice Address - State:IL
Practice Address - Zip Code:60526-1809
Practice Address - Country:US
Practice Address - Phone:312-810-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490038231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical