Healthcare Provider Details

I. General information

NPI: 1033916390
Provider Name (Legal Business Name): GRACE REESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 W OHIO ST STE 103
CHICAGO IL
60642-5874
US

IV. Provider business mailing address

840 W BLACKHAWK ST APT 713
CHICAGO IL
60642-2572
US

V. Phone/Fax

Practice location:
  • Phone: 312-772-9796
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: