Provider Demographics
NPI:1740595164
Name:GROSSHEIDER, JENNIFER L
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:GROSSHEIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 S STATE ST
Mailing Address - Street 2:SUITE 15 N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2973
Mailing Address - Country:US
Mailing Address - Phone:630-673-1211
Mailing Address - Fax:773-326-0725
Practice Address - Street 1:1530 S STATE ST
Practice Address - Street 2:SUITE 15 N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2973
Practice Address - Country:US
Practice Address - Phone:630-673-1211
Practice Address - Fax:773-326-0725
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst