Organization
BLAINE, GERSHENZON, AND HEINS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BONNIE E GERSHENZON MSW AND MA (PSYCHOTHERAPIST)
(847) 480-9671
Entity
Organization
Contact information
Practice address
3411 VANTAGE LN, GLENVIEW, IL 60026-1366
(847) 480-9671
(312) 372-0607
Mailing address
3411 VANTAGE LN, GLENVIEW, IL 60026-1366
(847) 480-9671
(312) 372-0607
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.003586
IL
1041C0700X
Clinical Social Worker
LCSW149000197
IL
1041C0700X
Clinical Social Worker
LCSW149005279
IL
Other
Enumeration date
10/29/2008
Last updated
10/29/2008
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