MEDICARE: JONATHON M GRUSZECZKI LCPC

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	101YM0800X	Mental Health Counselor	180.008983	IL

General Provider Information

NPI Number	:	1710305685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHON M GRUSZECZKI LCPC

Provider Business Mailing Address
First Line	:	1121 E MAIN ST STE 320
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60174-2276
Country	:	US
Telephone Number	:	630-344-9427
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 E MAIN ST STE 320
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60174-2276
Country	:	US
Telephone Number	:	630-344-9427
Fax Number	:

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

Provider Enumeration Date	:	03/28/2014
Last Update Date	:	02/11/2026

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