Provider Demographics
NPI:1366527624
Name:GRASTON, BILL EVERETT (LCSW)
Entity type:Individual
Prefix:
First Name:BILL
Middle Name:EVERETT
Last Name:GRASTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1138
Mailing Address - Country:US
Mailing Address - Phone:847-475-3515
Mailing Address - Fax:
Practice Address - Street 1:636 CHURCH ST STE 419B
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4580
Practice Address - Country:US
Practice Address - Phone:847-475-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical