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General NPI Number Information
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NPI Number | 1649480856
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Entity Type | Individual
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Provider Name | AMY S GROESSL PHD, LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 564 W RANDOLPH ST 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60661-2218
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Country | US
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Telephone | 773-991-3655
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 W NORTH SHORE AVE # 3E
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City | CHICAGO
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State | IL
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Zip | 60626-4617
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Country | US
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Telephone | 773-991-3655
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149011114
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License Number State | IL
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