Healthcare Provider Details

I. General information

NPI: 1679400626
Provider Name (Legal Business Name): JOHN GARDINER LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 E ONTARIO ST STE 1000
CHICAGO IL
60611-5424
US

IV. Provider business mailing address

1031 W BRYN MAWR AVE APT 3A
CHICAGO IL
60660-5113
US

V. Phone/Fax

Practice location:
  • Phone: 847-774-1271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180018215
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: