Healthcare Provider Details

I. General information

NPI: 1528390929
Provider Name (Legal Business Name): MAKING THE DIFFERENCE INTERNATIONAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 01/26/2024
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S WABASH AVE STE 302
CHICAGO IL
60605-2536
US

IV. Provider business mailing address

27 N WACKER DR SUITE 166
CHICAGO IL
60606-2800
US

V. Phone/Fax

Practice location:
  • Phone: 312-607-1385
  • Fax: 312-277-6113
Mailing address:
  • Phone: 312-607-1385
  • Fax: 773-548-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.008422
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. GAIL MARIE GRABCZYNSKI
Title or Position: OWNER
Credential: EDD
Phone: 312-607-1385