Provider Demographics
NPI:1427526193
Name:GERDOVICH, MACAYLA MARIE (LPC)
Entity type:Individual
Prefix:MRS
First Name:MACAYLA
Middle Name:MARIE
Last Name:GERDOVICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:MACAYLA
Other - Middle Name:MARIE
Other - Last Name:MAYNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:825 N 2401ST RD
Mailing Address - Street 2:
Mailing Address - City:OGLESBY
Mailing Address - State:IL
Mailing Address - Zip Code:61348-9750
Mailing Address - Country:US
Mailing Address - Phone:815-343-8344
Mailing Address - Fax:
Practice Address - Street 1:643 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2717
Practice Address - Country:US
Practice Address - Phone:866-541-5299
Practice Address - Fax:815-214-2101
Is Sole Proprietor?:No
Enumeration Date:2018-11-11
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2368884101YS0200X
IL178.013904101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool