Provider Demographics
NPI:1053714790
Name:GRIMARD WILSON CONSULTING, INC.
Entity type:Organization
Organization Name:GRIMARD WILSON CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:GRIMARD
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, BCN
Authorized Official - Phone:312-925-5176
Mailing Address - Street 1:333 W WACKER DR STE 500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-2218
Mailing Address - Country:US
Mailing Address - Phone:312-925-5176
Mailing Address - Fax:
Practice Address - Street 1:333 W WACKER DR STE 500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-2218
Practice Address - Country:US
Practice Address - Phone:312-925-5176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty