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General NPI Number Information
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NPI Number | 1376645630
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Entity Type | Individual
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Provider Name | DIANNE GERARD MS, LCPC
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Gender | Female
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 1000 HART RD STE 130
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City | BARRINGTON
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State | IL
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Zip | 60010-2668
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Country | US
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Telephone | 847-334-8445
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Fax |
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Provider Business Mailing Address
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Address Line | 2112 ASCOT LN
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City | SPRING GROVE
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State | IL
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Zip | 60081-8040
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Country | US
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Telephone | 847-334-8445
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178-003661
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180006512
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License Number State | IL
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