Individual
ILANA GRENDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5230 S 6TH STREET RD, SPRINGFIELD, IL 62703-5128
(217) 585-1180
(217) 585-4747
Mailing address
5230 S 6TH STREET RD, SPRINGFIELD, IL 62703-5128
(217) 585-1180
(217) 585-4747
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
149016364
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149016364
LICENSED CLINICAL SOCIAL WORKER
IL
Enumeration date
12/18/2013
Last updated
12/18/2013
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