Provider Demographics
NPI:1669021986
Name:GRAUB, JOHN NICHOLAS (PSYD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:NICHOLAS
Last Name:GRAUB
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:GRAUB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1451 MERCHANT DR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5917
Mailing Address - Country:US
Mailing Address - Phone:847-469-7537
Mailing Address - Fax:847-469-7540
Practice Address - Street 1:1451 MERCHANT DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5917
Practice Address - Country:US
Practice Address - Phone:847-469-7537
Practice Address - Fax:847-469-7540
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF8298407Medicaid