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General NPI Number Information
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NPI Number | 1093341513
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Entity Type | Individual
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Provider Name | ELLEN GRENEN LSW
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Gender | Female
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Dates
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Enumeration Date | 03/16/2020
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 3047 N LINCOLN AVE UNIT 400
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City | CHICAGO
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State | IL
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Zip | 60657-4274
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Country | US
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Telephone | 412-780-8834
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Fax |
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Provider Business Mailing Address
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Address Line | 2122 N. BISSELL STEET GARDEN UNIT
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City | CHICAGO
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State | IL
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Zip | 60614
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Country | US
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Telephone |
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 150104050
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License Number State | IL
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