Healthcare Provider Details

I. General information

NPI: 1508659269
Provider Name (Legal Business Name): AMANDA GRZESLO CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15900 W 127TH ST STE 201
LEMONT IL
60439-2912
US

IV. Provider business mailing address

7014 CENTURY CT
TINLEY PARK IL
60477-5486
US

V. Phone/Fax

Practice location:
  • Phone: 630-281-2496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: