Individual
GRACE ELIZABETH LONGSTRETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1701 CLEARWATER AVE STE D, BLOOMINGTON, IL 61704-6434
(309) 590-6788
Mailing address
616 IAA DR, BLOOMINGTON, IL 61701-2225
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
178.022113
IL
Other
Enumeration date
05/14/2025
Last updated
09/24/2025
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