Provider Demographics
NPI:1750583761
Name:GRULKE, LISA SPIEKYS (LCPC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SPIEKYS
Last Name:GRULKE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-5704
Mailing Address - Country:US
Mailing Address - Phone:630-830-7842
Mailing Address - Fax:
Practice Address - Street 1:1002 CONCORD DR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-5704
Practice Address - Country:US
Practice Address - Phone:630-830-7842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional