Individual
DR. GWEN IRENE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
14953 S VAN DYKE RD, PLAINFIELD, IL 60544-5804
(773) 620-6512
Mailing address
17120 W 145TH ST, LOCKPORT, IL 60441-2297
(773) 620-6512
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071007699
IL
Other
Enumeration date
06/08/2015
Last updated
10/12/2015
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