Provider Demographics
NPI:1710058169
Name:GROEZINGER, JILL J (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:J
Last Name:GROEZINGER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13300 S RTE 59
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-9847
Mailing Address - Country:US
Mailing Address - Phone:815-577-3666
Mailing Address - Fax:
Practice Address - Street 1:3033 OGDEN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1673
Practice Address - Country:US
Practice Address - Phone:630-527-1664
Practice Address - Fax:630-983-0162
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional