Healthcare Provider Details

I. General information

NPI: 1407817679
Provider Name (Legal Business Name): JOEL MARTIN GRONER PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 DUNDEE RD STE 1701
NORTHBROOK IL
60062
US

IV. Provider business mailing address

666 DUNDEE RD STE 1701
NORTHBROOK IL
60062
US

V. Phone/Fax

Practice location:
  • Phone: 847-604-4069
  • Fax: 847-564-7706
Mailing address:
  • Phone: 847-604-4069
  • Fax: 847-564-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: