MEDICARE: DR. GRADY L GARNER-OSTEN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1013339092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRADY L GARNER-OSTEN PH.D.

Provider Business Mailing Address
First Line	:	1700 W IRVING PARK RD
Second Line	:	STE #301
City	:	CHICAGO
State	:	IL
Zip	:	60613-2559
Country	:	US
Telephone Number	:	773-401-1607
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 W IRVING PARK RD
Second Line	:	STE #301
City	:	CHICAGO
State	:	IL
Zip	:	60613-2559
Country	:	US
Telephone Number	:	773-401-1607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2014
Last Update Date	:	01/10/2014

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