Healthcare Provider Details

I. General information

NPI: 1114850708
Provider Name (Legal Business Name): ELENA JOANNA PLAMENOVA GRANTCHARSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 E WOODFIELD RD STE 220
SCHAUMBURG IL
60173-6068
US

IV. Provider business mailing address

1056 COVE DR
PROSPECT HEIGHTS IL
60070-1903
US

V. Phone/Fax

Practice location:
  • Phone: 312-210-0175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.022809
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: