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General NPI Number Information
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NPI Number | 1962785576
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Entity Type | Individual
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Provider Name | MARY KATHLEEN MCGOWAN GRUBER L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9150 CRAWFORD AVE STE 107
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City | SKOKIE
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State | IL
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Zip | 60076-1769
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Country | US
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Telephone | 847-702-2218
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Fax | 847-677-4183
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Provider Business Mailing Address
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Address Line | 60 WILLIAMSBURG RD
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City | EVANSTON
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State | IL
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Zip | 60203-1813
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Country | US
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Telephone | 847-702-2218
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Fax | 847-677-4183
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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 | 149005682
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149-005682
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License Number State | IL
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