Provider Demographics
NPI:1710305685
Name:GRUSZECZKI, JONATHON M (LCPC)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:M
Last Name:GRUSZECZKI
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ILLINOIS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1866
Mailing Address - Country:US
Mailing Address - Phone:773-570-0596
Mailing Address - Fax:
Practice Address - Street 1:100 ILLINOIS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1866
Practice Address - Country:US
Practice Address - Phone:773-570-0596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health