Healthcare Provider Details

I. General information

NPI: 1336930957
Provider Name (Legal Business Name): JONATHAN GAUERKE LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4812 N SHERIDAN RD STE A
PEORIA IL
61614-5997
US

IV. Provider business mailing address

55 E JACKSON BLVD STE 1500
CHICAGO IL
60604-4184
US

V. Phone/Fax

Practice location:
  • Phone: 877-381-6538
  • Fax: 309-271-0990
Mailing address:
  • Phone: 312-663-1300
  • Fax: 312-663-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150113180
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149030777
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: