Provider Demographics
NPI:1881306462
Name:GEWENIGER, ERIC ROBERT (MA, LPC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ROBERT
Last Name:GEWENIGER
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5727 N WINTHROP AVE APT 408
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4396
Mailing Address - Country:US
Mailing Address - Phone:312-690-3206
Mailing Address - Fax:
Practice Address - Street 1:5153 N CLARK ST STE 306
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-6850
Practice Address - Country:US
Practice Address - Phone:312-690-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.018705101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health