Provider Demographics
NPI:1568445286
Name:GROSS, FREDERICK WALTER (MSW)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:WALTER
Last Name:GROSS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9251 S OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-6218
Mailing Address - Country:US
Mailing Address - Phone:773-239-1221
Mailing Address - Fax:773-239-7968
Practice Address - Street 1:10540 S WESTERN AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2536
Practice Address - Country:US
Practice Address - Phone:773-239-0404
Practice Address - Fax:773-239-7968
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL197088OtherCOMPSYCH
IL0001671347OtherBLUE CROSS
IL16467890OtherUBH
IL0001671347OtherBLUE CROSS