Healthcare Provider Details

I. General information

NPI: 1093328486
Provider Name (Legal Business Name): MARLENA CHRISTINE GEBHARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 N CLARK ST # 1099
CHICAGO IL
60640-2829
US

IV. Provider business mailing address

1090 S WADSWORTH BLVD STE C
LAKEWOOD CO
80226-4350
US

V. Phone/Fax

Practice location:
  • Phone: 615-521-1071
  • Fax:
Mailing address:
  • Phone: 970-414-7606
  • Fax: 970-834-6873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.104560
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.025532
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: