MEDICARE: WELLINGTON PSYCHOLOGICAL SERVICES, PC

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	103TC0700X	Clinical Psychologist	071007375	IL

General Provider Information

NPI Number	:	1730525148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLINGTON PSYCHOLOGICAL SERVICES, PC

Provider Business Mailing Address
First Line	:	1700 W IRVING PARK RD STE 112
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2559
Country	:	US
Telephone Number	:	312-402-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 W IRVING PARK RD STE 112
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2559
Country	:	US
Telephone Number	:	312-402-0550
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GRACE PALACIO
Credential	:	PSYD
Telephone Number	:	312-402-0550

Provider Enumeration Date	:	05/13/2013
Last Update Date	:	06/15/2026

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