Healthcare Provider Details

I. General information

NPI: 1104696632
Provider Name (Legal Business Name): GRAYCE QUICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRAYCE HIGHTSHOE

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 DEKALB AVE
SYCAMORE IL
60178-3114
US

IV. Provider business mailing address

1950 DEKALB AVE
SYCAMORE IL
60178-3114
US

V. Phone/Fax

Practice location:
  • Phone: 779-201-6440
  • Fax:
Mailing address:
  • Phone: 779-201-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.033184
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: