Provider Demographics
NPI:1831427350
Name:GRANT, AMY L (LSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:GRANT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2259 MASTERS LN
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-4137
Mailing Address - Country:US
Mailing Address - Phone:847-791-8932
Mailing Address - Fax:
Practice Address - Street 1:34121 N US HIGHWAY 45 STE 226
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1777
Practice Address - Country:US
Practice Address - Phone:224-880-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.105925104100000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No174400000XOther Service ProvidersSpecialist