Provider Demographics
NPI:1023021607
Name:GRZELAK, CARIN NESS (PSYD)
Entity Type:Individual
Prefix:
First Name:CARIN NESS
Middle Name:
Last Name:GRZELAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:ARROWSMITH
Mailing Address - State:IL
Mailing Address - Zip Code:61722-0115
Mailing Address - Country:US
Mailing Address - Phone:309-688-9979
Mailing Address - Fax:309-688-9111
Practice Address - Street 1:75 E QUEENWOOD RD
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2985
Practice Address - Country:US
Practice Address - Phone:309-263-5565
Practice Address - Fax:309-263-9336
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist