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Grace Domzalski

Individual provider Active NPI Clinical Psychologist · Inverness, IL

NPI 1992285647 · NPPES record last updated May 9, 2023

Key facts

NPI
1992285647
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Psychologist 103TC0700X
License
071.010965 (IL)
Practice address
1602 W Colonial Pkwy Ste 200
Inverness, IL 60067-1215
Phone
(847) 364-0163
NPI assigned
Aug 21, 2018
Sex
Female
Sole proprietor
No

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
071.010965ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Serenity Counseling and Wellness Current
since Sep 1, 2024		 Accepting new patients

Locations

1602 W Colonial Pkwy
Ste 200
Inverness, IL 60067
Phone (847) 349-0163

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071.010965 IL Yes

Addresses

Primary practice location

1602 W Colonial Pkwy Ste 200
Inverness, IL 60067-1215

Mailing address

1602 W Colonial Pkwy Ste 200
Inverness, IL 60067-1215
Phone (847) 364-0163

Other providers in Inverness, IL

All providers in Inverness, IL · Clinical Psychologist in Illinois

Sources for this page

Verify at the official NPI Registry.