Provider Demographics
NPI:1194438069
Name:CANERDAY, GINA MARGARET
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARGARET
Last Name:CANERDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1054
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-9154
Mailing Address - Country:US
Mailing Address - Phone:708-378-5401
Mailing Address - Fax:
Practice Address - Street 1:701 E 31ST ST # 1054
Practice Address - Street 2:
Practice Address - City:LA GRANGE PARK
Practice Address - State:IL
Practice Address - Zip Code:60526-9800
Practice Address - Country:US
Practice Address - Phone:708-378-5401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0248751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical