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General NPI Number Information
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NPI Number | 1376352658
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Entity Type | Individual
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Provider Name | JILL VARADY GRANOFF PHD
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Gender | Female
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 5000 S 5TH AVE
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City | HINES
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State | IL
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Zip | 60141-3030
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Country | US
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Telephone | 708-202-8397
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Fax |
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Provider Business Mailing Address
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Address Line | 150 N ASHLAND AVE UNIT 214
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City | CHICAGO
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State | IL
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Zip | 60607-5222
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Country | US
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Telephone | 312-841-0593
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5301-57
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License Number State | WI
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