Active NPI
Anita Groll
- Professional Counselor
- Park Ridge, IL
National Provider Identifier
1043631963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.005177
- Practice address
- 1580 N Northwest Hwy
Suite 111-G
Park Ridge, IL 60068-1444 - Phone
- (708) 925-3540
- NPI assigned
- Dec 18, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.005177 | IL | Primary |
Addresses
Primary practice location
1580 N Northwest Hwy
Suite 111-G
Park Ridge, IL 60068-1444
Mailing address
4707 N Oketo Ave
Harwood Heights, IL 60706-4612
Phone (708) 925-3540
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.005177 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Groll Therapy LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Park Ridge, IL
- NPI 1275199846
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452384000000",
"number": "1043631963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4707 N OKETO AVE",
"city": "HARWOOD HEIGHTS",
"state": "IL",
"postal_code": "607064612",
"telephone_number": "708-925-3540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1580 N NORTHWEST HWY",
"address_2": "SUITE 111-G",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600681444",
"telephone_number": "708-925-3540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROLL",
"first_name": "ANITA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-18",
"last_updated": "2016-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.005177",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.