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General NPI Number Information
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NPI Number | 1831052299
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Entity Type | Individual
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Provider Name | ALEXIS MCGRUDER
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Gender | Female
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 142 HAWLEY ST STE 5
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City | GRAYSLAKE
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State | IL
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Zip | 60030-3653
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Country | US
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Telephone | 847-962-9549
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Fax |
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Provider Business Mailing Address
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Address Line | 847 SANCTUARY DR APT 305B
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City | LAKE VILLA
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State | IL
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Zip | 60046-4403
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Country | US
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Telephone | 262-374-3567
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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 |
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License Number State |
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