Healthcare Provider Details

I. General information

NPI: 1639073794
Provider Name (Legal Business Name): OLIVIA GROSSKLAUS MS, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 N CLARK ST STE 411
CHICAGO IL
60610-7473
US

IV. Provider business mailing address

1165 N CLARK ST STE 411
CHICAGO IL
60610-7473
US

V. Phone/Fax

Practice location:
  • Phone: 480-684-0935
  • Fax:
Mailing address:
  • Phone: 480-684-0935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.012311
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: