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General NPI Number Information
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NPI Number | 1336930957
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Entity Type | Individual
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Provider Name | JONATHAN GAUERKE LSW
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Gender | Male
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 4812 N SHERIDAN RD STE A
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City | PEORIA
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State | IL
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Zip | 61614-5997
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Country | US
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Telephone | 877-381-6538
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Fax | 309-271-0990
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Provider Business Mailing Address
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Address Line | 55 E JACKSON BLVD STE 1500
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City | CHICAGO
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State | IL
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Zip | 60604-4184
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Country | US
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Telephone | 312-663-1300
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Fax | 312-663-0504
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149030777
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150113180
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License Number State | IL
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