Healthcare Provider Details

I. General information

NPI: 1710058169
Provider Name (Legal Business Name): JILL J GROEZINGER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 OGDEN AVE SUITE 210
LISLE IL
60532-1673
US

IV. Provider business mailing address

13300 S RTE 59
PLAINFIELD IL
60585-9847
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-1664
  • Fax: 630-983-0162
Mailing address:
  • Phone: 815-577-3666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180005176
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: