Individual
ILANA GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
36 MAIN ST, PARK RIDGE, IL 60068-4059
(847) 692-6692
Mailing address
36 MAIN ST, PARK RIDGE, IL 60068-4059
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071009732
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071009732
CLINICAL PSYCHOLOGIST
IL
Enumeration date
05/11/2018
Last updated
05/11/2018
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