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General NPI Number Information
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NPI Number | 1992704225
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Entity Type | Individual
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Provider Name | ROGER C GRONAU PHD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 527 W SOUTH ST
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City | WOODSTOCK
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State | IL
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Zip | 60098-3756
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Country | US
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Telephone | 815-338-9199
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Fax | 815-338-9205
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Provider Business Mailing Address
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Address Line | 970 MCHENRY AVE
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7449
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Country | US
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Telephone | 815-455-7100
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Fax | 815-455-3951
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1957-057
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | IL
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