Healthcare Provider Details

I. General information

NPI: 1790927770
Provider Name (Legal Business Name): MONICA K. FERKIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NATIONS DR
GURNEE IL
60031-9168
US

IV. Provider business mailing address

7285 CLEM DR
GURNEE IL
60031-5194
US

V. Phone/Fax

Practice location:
  • Phone: 224-501-5102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6617-123
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.000023
License Number StateIL

VIII. Authorized Official

Name: MONICA K. FERKIN
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW, CADC, CEAP
Phone: 847-770-7202