Healthcare Provider Details

I. General information

NPI: 1982820429
Provider Name (Legal Business Name): LAURA GILBERT GERBER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 REVERE DR STE B
NORTHBROOK IL
60062-8001
US

IV. Provider business mailing address

411 KELBURN RD APT 324
DEERFIELD IL
60015-4385
US

V. Phone/Fax

Practice location:
  • Phone: 847-997-7470
  • Fax:
Mailing address:
  • Phone: 847-933-0051
  • Fax: 847-933-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-003770
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: