Provider Demographics
NPI:1114080686
Name:GRUNNET-ALDEN, VICKI (PHD, LCSW, MSW)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:
Last Name:GRUNNET-ALDEN
Suffix:
Gender:F
Credentials:PHD, LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 RESOURCE PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-5334
Mailing Address - Country:US
Mailing Address - Phone:630-297-3617
Mailing Address - Fax:630-845-0974
Practice Address - Street 1:3301 RESOURCE PKWY STE 3
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-5334
Practice Address - Country:US
Practice Address - Phone:630-297-3617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0093581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232366OtherBLUE CROSS BLUE SHIELD
IL2232366OtherBLUE CROSS BLUE SHIELD