Healthcare Provider Details

I. General information

NPI: 1891014429
Provider Name (Legal Business Name): MICHELLE D GEBHARDT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N MICHIGAN AVE STE 1900
CHICAGO IL
60601-3994
US

IV. Provider business mailing address

333 N MICHIGAN AVE STE 1900
CHICAGO IL
60601-3994
US

V. Phone/Fax

Practice location:
  • Phone: 773-321-2837
  • Fax:
Mailing address:
  • Phone: 773-321-2831
  • Fax: 312-540-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-007810
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: