Healthcare Provider Details

I. General information

NPI: 1619267259
Provider Name (Legal Business Name): MEGHAN GRZETICH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2011
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2728 CATON FARM RD
JOLIET IL
60435-1309
US

IV. Provider business mailing address

2728 CATON FARM RD
JOLIET IL
60435-1309
US

V. Phone/Fax

Practice location:
  • Phone: 815-714-8847
  • Fax:
Mailing address:
  • Phone: 815-714-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166000822
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: