Provider Demographics
NPI:1588834196
Name:GRENKE, ERIN K (LCPC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:K
Last Name:GRENKE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:K
Other - Last Name:WILER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:5702 ELAINE DR STE A
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2463
Mailing Address - Country:US
Mailing Address - Phone:815-977-9947
Mailing Address - Fax:815-399-1959
Practice Address - Street 1:5702 ELAINE DR
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2458
Practice Address - Country:US
Practice Address - Phone:815-977-9947
Practice Address - Fax:815-399-1959
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006384101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional