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NPI Code Detail

MEDICARE: DIANNE GERARD MS, LCPC

MEDICARE: DIANNE GERARD MS, LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor178-003661IL
2101YP2500XProfessional Counselor180006512IL

General Provider Information

NPI Number : 1376645630
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANNE GERARD MS, LCPC
Provider Business Mailing Address
First Line : 2112 ASCOT LN
Second Line :
City : SPRING GROVE
State : IL
Zip : 60081-8040
Country : US
Telephone Number : 847-334-8445
Fax Number :
Provider Business Practice Location Address
First Line : 1000 HART RD STE 130
Second Line :
City : BARRINGTON
State : IL
Zip : 60010-2668
Country : US
Telephone Number : 847-334-8445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2006
Last Update Date : 05/18/2022

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