Provider Demographics
NPI:1255604187
Name:ANN JULIA GERUT LCSW, INC.
Entity type:Organization
Organization Name:ANN JULIA GERUT LCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:JULIA
Authorized Official - Last Name:GERUT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-925-8737
Mailing Address - Street 1:611 N CUYLER AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1702
Mailing Address - Country:US
Mailing Address - Phone:312-925-8737
Mailing Address - Fax:708-524-2709
Practice Address - Street 1:801 SOUTH BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2860
Practice Address - Country:US
Practice Address - Phone:312-925-8737
Practice Address - Fax:708-524-2709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490070591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty