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General NPI Number Information
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NPI Number | 1487128559
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Entity Type | Organization
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Legal Business Name | SHIVROUP K. GREWAL, PSYD, LLC
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 01/11/2019
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Provider Practice Location Address
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Address Line | 2724 N KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-1514
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Country | US
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Telephone | 312-508-3970
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Fax |
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Provider Business Mailing Address
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Address Line | 2318 W HARRISON ST APT 4
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City | CHICAGO
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State | IL
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Zip | 60612-3674
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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 | CLINICAL PSYCHOLOGIST/OWNER
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Name | SHIVROUP GREWAL
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Credential |
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Telephone | 312-508-3970
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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 |
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