Healthcare Provider Details

I. General information

NPI: 1316224413
Provider Name (Legal Business Name): KLARECE LYNN GRUDZINSKI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KLARECE LYNN ERICKSON

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8697 LA MESA BLVD STE C
LA MESA CA
91942-9565
US

IV. Provider business mailing address

1559 CHISWICK CT
EL CAJON CA
92020-2967
US

V. Phone/Fax

Practice location:
  • Phone: 619-850-2570
  • Fax: 619-610-9287
Mailing address:
  • Phone: 619-850-2570
  • Fax: 619-610-9287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number79276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: