Provider Demographics
NPI:1134694961
Name:NOSEWICZ, GRACIA
Entity type:Individual
Prefix:
First Name:GRACIA
Middle Name:
Last Name:NOSEWICZ
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 1:933 WESTFIELD CRSE
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3428
Mailing Address - Country:US
Mailing Address - Phone:630-208-6811
Mailing Address - Fax:
Practice Address - Street 1:311 N 2ND ST STE 302
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1853
Practice Address - Country:US
Practice Address - Phone:331-222-7089
Practice Address - Fax:630-590-9991
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty