Healthcare Provider Details

I. General information

NPI: 1861074254
Provider Name (Legal Business Name): GROUNDED HEALING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2021
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 W 18TH ST STE 203
CHICAGO IL
60608-2400
US

IV. Provider business mailing address

917 W 18TH ST STE 203
CHICAGO IL
60608-2400
US

V. Phone/Fax

Practice location:
  • Phone: 312-620-5241
  • Fax: 312-680-5655
Mailing address:
  • Phone: 312-620-5241
  • Fax: 312-680-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMANTHA COLLAZO
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 312-620-5241