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General NPI Number Information
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NPI Number | 1427884865
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Entity Type | Individual
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Provider Name | EMMA ROSE GROSS LSW
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Gender |
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Dates
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Enumeration Date | 09/11/2024
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 1525 E 53RD ST STE 623
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City | CHICAGO
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State | IL
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Zip | 60615-4530
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Country | US
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Telephone | 872-204-6668
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Fax |
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Provider Business Mailing Address
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Address Line | 1425 N CALIFORNIA AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60622-2345
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.114202
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License Number State | IL
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