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General NPI Number Information
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NPI Number | 1811408883
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Entity Type | Organization
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Legal Business Name | CHRISTI LGARDNER
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Dates
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Enumeration Date | 10/18/2017
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 6033 N SHERIDAN RD # CW04S-02
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City | CHICAGO
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State | IL
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Zip | 60660-3003
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Country | US
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Telephone | 773-359-3505
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Fax | 877-505-2823
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Provider Business Mailing Address
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Address Line | 6325 N SHERIDAN RD APT 804
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City | CHICAGO
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State | IL
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Zip | 60660-5708
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Country | US
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Telephone | 773-793-5559
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Fax | 877-505-2823
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTI L GARDNER
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Credential | LCSW, CADC
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Telephone | 773-359-3505
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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 | 149006362
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149018427
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License Number State | IL
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