Provider Demographics
NPI:1104133552
Name:GEHRKE, CARYN ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CARYN
Middle Name:ANNE
Last Name:GEHRKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36859 N STANTON POINT RD
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60041-8411
Mailing Address - Country:US
Mailing Address - Phone:847-561-4707
Mailing Address - Fax:847-587-0571
Practice Address - Street 1:36859 N STANTON POINT RD
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:IL
Practice Address - Zip Code:60041-8411
Practice Address - Country:US
Practice Address - Phone:847-561-4707
Practice Address - Fax:847-587-0571
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0143011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical