Provider Demographics
NPI:1245819986
Name:GRADY, PHYLLIS KUI
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:KUI
Last Name:GRADY
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 1:5860 N MERRIMAC AVE UNIT G
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5325
Mailing Address - Country:US
Mailing Address - Phone:872-806-4355
Mailing Address - Fax:
Practice Address - Street 1:191 WAUKEGAN RD STE 206
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-2743
Practice Address - Country:US
Practice Address - Phone:847-251-7350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist