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General NPI Number Information
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NPI Number | 1902489552
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Entity Type | Individual
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Provider Name | GRACE PELZER
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Gender | Female
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Dates
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Enumeration Date | 05/02/2021
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 540 W FRONTAGE RD STE 2215
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City | NORTHFIELD
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State | IL
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Zip | 60093-1228
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Country | US
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Telephone | 847-848-0697
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Fax |
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Provider Business Mailing Address
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Address Line | 3446 N DAMEN AVE # 1
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City | CHICAGO
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State | IL
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Zip | 60618-6106
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Country | US
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Telephone | 815-228-0782
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.016306
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.014034
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License Number State | IL
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