Provider Demographics
NPI:1912930066
Name:MOEHLER, GERDA THERESE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GERDA
Middle Name:THERESE
Last Name:MOEHLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S PINE ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3133
Mailing Address - Country:US
Mailing Address - Phone:312-400-9110
Mailing Address - Fax:
Practice Address - Street 1:101 S PINE ST
Practice Address - Street 2:SUITE #2
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3133
Practice Address - Country:US
Practice Address - Phone:312-400-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-71016OtherBLUE CROSS BLUE SHIELD
IL016-71016OtherBLUE CROSS BLUE SHIELD