Healthcare Provider Details

I. General information

NPI: 1588596803
Provider Name (Legal Business Name): DAWN GRUICHICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5630 S MARINE DR
TEMPE AZ
85283-2128
US

IV. Provider business mailing address

5630 S MARINE DR
TEMPE AZ
85283-2128
US

V. Phone/Fax

Practice location:
  • Phone: 480-200-1863
  • Fax:
Mailing address:
  • Phone: 480-200-1863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-11060
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: