Provider Demographics
NPI:1619267259
Name:GRZETICH, MEGHAN (LMFT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:GRZETICH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 CATON FARM RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-1309
Mailing Address - Country:US
Mailing Address - Phone:815-714-8847
Mailing Address - Fax:
Practice Address - Street 1:2728 CATON FARM RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-1309
Practice Address - Country:US
Practice Address - Phone:815-714-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-16
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
IL166000822106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist