Healthcare Provider Details

I. General information

NPI: 1790510543
Provider Name (Legal Business Name): NATALIE MARIE GRUBCZAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 GRAND AVE STE 1
FRANKLIN PARK IL
60131-2564
US

IV. Provider business mailing address

10001 GRAND AVE STE 1
FRANKLIN PARK IL
60131-2564
US

V. Phone/Fax

Practice location:
  • Phone: 847-451-0330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: