Provider Demographics
NPI:1730544495
Name:GARDNER, ERIN (LCPC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2301 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5481
Mailing Address - Country:US
Mailing Address - Phone:815-730-8221
Mailing Address - Fax:
Practice Address - Street 1:2301 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5481
Practice Address - Country:US
Practice Address - Phone:815-730-8221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010498101YP2500X
IL178007961101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional