Healthcare Provider Details

I. General information

NPI: 1528178308
Provider Name (Legal Business Name): JOEL M GRONER PSY D PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 DUNDEE ROAD SUITE 1701
NORTHBROOK IL
60062
US

IV. Provider business mailing address

666 DUNDEE ROAD SUITE 1701
NORTHBROOK IL
60062
US

V. Phone/Fax

Practice location:
  • Phone: 847-850-9420
  • Fax: 847-892-7301
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 Number071004322
License Number StateIL

VIII. Authorized Official

Name: MR. JOEL MARTIN GRONER
Title or Position: OWNER
Credential: PSY D
Phone: 847-604-4069