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General NPI Number Information
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NPI Number | 1023154762
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Entity Type | Individual
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Provider Name | DANIEL E GROHENS PHD LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 02/25/2018
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Provider Practice Location Address
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Address Line | 6072 BRYNWOOD DR STE 208
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City | ROCKFORD
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State | IL
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Zip | 61114-5829
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Country | US
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Telephone | 815-721-1320
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Fax |
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Provider Business Mailing Address
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Address Line | 11520 BEND RIVER RD
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City | ROSCOE
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State | IL
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Zip | 61073
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Country | US
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Telephone | 815-721-1320
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Fax | 815-623-1938
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 149006360
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License Number State | IL
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