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General NPI Number Information
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NPI Number | 1508748567
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Entity Type | Organization
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Legal Business Name | GRACE BOTHWELL, PLLC
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 3717 N RAVENSWOOD AVE STE 220W
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City | CHICAGO
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State | IL
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Zip | 60613-3899
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Country | US
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Telephone | 608-359-6729
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 W TAYLOR ST # 1333
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City | CHICAGO
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State | IL
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Zip | 60607-4623
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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 | MEMBER
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Name | GRACE BOTHWELL
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Credential | LCSW
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Telephone | 608-359-6729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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