Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1013339092 |
---|---|
Provider Name | Dr. Grady L Garner-Osten |
First Address | Chicago, IL 60613-2559 |
Second Address | Chicago, IL 60613-2559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2014 |
Last Update Date | 10/01/2014 |