Provider Demographics
NPI:1740564673
Name:GRISHAM, LYNSEY (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNSEY
Middle Name:
Last Name:GRISHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 N JANSSEN AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2615
Mailing Address - Country:US
Mailing Address - Phone:610-996-0837
Mailing Address - Fax:
Practice Address - Street 1:4256 N RAVENSWOOD AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1110
Practice Address - Country:US
Practice Address - Phone:610-996-0837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490148111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical