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General NPI Number Information
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NPI Number | 1376716506
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Entity Type | Individual
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Provider Name | DR. JAMES STEPHAN GROT
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Gender | Male
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 500 ANCHOR RD
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City | DIXON
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State | IL
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Zip | 61021-8829
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Country | US
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Telephone | 815-288-6691
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Fax |
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Provider Business Mailing Address
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Address Line | 2240 SPANGLER CT
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City | DIXON
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State | IL
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Zip | 61021-9037
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Country | US
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Telephone | 815-652-3343
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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 |
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License Number State | IL
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