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General NPI Number Information
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NPI Number | 1518467448
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Entity Type | Individual
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Provider Name | JASON GERIG LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 4667 N MANOR AVE
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City | CHICAGO
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State | IL
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Zip | 60625-3717
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Country | US
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Telephone | 224-633-3966
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Fax |
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Provider Business Mailing Address
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Address Line | 4838 N PAULINA ST APT 3E
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City | CHICAGO
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State | IL
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Zip | 60640-4148
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Country | US
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Telephone | 773-949-4496
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149017951
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License Number State | IL
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