Healthcare Provider Details

I. General information

NPI: 1497076111
Provider Name (Legal Business Name): JAMIE L GRUSECKI AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12133 W BELL RD STE 201
SURPRISE AZ
85378-9408
US

IV. Provider business mailing address

12133 W BELL RD STE 201
SURPRISE AZ
85378-9408
US

V. Phone/Fax

Practice location:
  • Phone: 623-583-1737
  • Fax: 623-583-0607
Mailing address:
  • Phone: 623-583-1737
  • Fax: 623-583-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA4117
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: