| Doctor Name: | ANITA GROLL |
| NPI Number: | 1043631963 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 180.005177 |
| Business Practice Address: | 1580 N Northwest Hwy Suite 111-g Park Ridge, IL - 600681444 |
| Business Phone Number: | 7089253540 |
| Business Fax Number: | |
| Mailing Address: | 4707 N Oketo Ave, HARWOOD HEIGHTS |
| State: | IL |
| Postal Code: | 607064612 |
| Phone Number: | 7089253540 |
| Fax Number: | |
| NPI Enumeration Date: | 12/18/2013 |
| NPI Last Update Date: | 01/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 180.005177 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |