Healthcare Provider Details

I. General information

NPI: 1477289460
Provider Name (Legal Business Name): ELIZABETH KATHLEEN GRZAN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 W STATE ST STE 119D
GENEVA IL
60134-2079
US

IV. Provider business mailing address

1056 KILBERY LN
NORTH AURORA IL
60542-4629
US

V. Phone/Fax

Practice location:
  • Phone: 630-296-9566
  • Fax:
Mailing address:
  • Phone: 331-401-8173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150108433
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: