Jacqueline H Grygotis, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.005371 Issued in IL

Practice address

1021 Judson Ave
Evanston, IL 60202-1320

Phone

(847) 204-4172

Fax

(847) 328-7772

NPI assigned

Feb 16, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1447394135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 JUDSON AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602021320",
            "telephone_number": "847-204-4172",
            "fax_number": "847-328-7772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 JUDSON AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602021320",
            "telephone_number": "847-204-4172",
            "fax_number": "847-328-7772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRYGOTIS",
        "first_name": "JACQUELINE",
        "middle_name": "H",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-16",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.005371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rose Gruenwald
• Kenneth A Grumet, M.D.
• Catherine R Grund, L.C.S.W.
• Charles R Gruner, M.D.
• Kai Grunsten
• Jessica Grygotis, MD
• Brenda Guan, PT,DPT
• Matthew Guarascio
• Leanna S Gudel, M.A., L.P.C.
• Laura M Guengerich

• Clinical Social Worker in Evanston, IL
• Providers in Evanston, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.