MEDICARE: DR. JESSICA HEWETSON GRUBER BCBA-D, PHD, LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	152000103	IL

General Provider Information

NPI Number	:	1811303282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA HEWETSON GRUBER BCBA-D, PHD, LBA

Provider Business Mailing Address
First Line	:	8609 W BRYN MAWR AVE STE 204
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3524
Country	:	US
Telephone Number	:	708-306-2744
Fax Number	:	224-241-3132

Provider Business Practice Location Address
First Line	:	2701 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3919
Country	:	US
Telephone Number	:	224-258-2570
Fax Number	:	224-241-3132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2014
Last Update Date	:	03/31/2025

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