=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093601890
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GRACE EAGER LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2025
-----------------------------------------------------
Last Update Date | 06/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1916 N MAIN ST
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61356-9710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-872-2943
-----------------------------------------------------
Fax | 815-915-8756
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1916 N MAIN ST
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61356-9710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-872-2943
-----------------------------------------------------
Fax | 815-915-8756
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149029408
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------