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NPI Code Detail

MEDICARE: ERIC ROBERT GEWENIGER MA, LPC

MEDICARE: ERIC ROBERT GEWENIGER MA, LPC
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
1101YM0800XMental Health Counselor178.018705IL

General Provider Information

NPI Number : 1881306462
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC ROBERT GEWENIGER MA, LPC
Provider Business Mailing Address
First Line : 5727 N WINTHROP AVE APT 408
Second Line :
City : CHICAGO
State : IL
Zip : 60660-4396
Country : US
Telephone Number : 312-690-3206
Fax Number :
Provider Business Practice Location Address
First Line : 5153 N CLARK ST STE 306
Second Line :
City : CHICAGO
State : IL
Zip : 60640-6850
Country : US
Telephone Number : 312-690-3206
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2022
Last Update Date : 12/15/2022

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