Healthcare Provider Details

I. General information

NPI: 1093598401
Provider Name (Legal Business Name): KAILEE GRONOW PSY, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25170 HANCOCK AVE STE 250
MURRIETA CA
92562-5969
US

IV. Provider business mailing address

11752 EL CAMINO REAL STE 100
SAN DIEGO CA
92130-2050
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-8300
  • Fax:
Mailing address:
  • Phone: 858-793-9591
  • Fax: 858-966-8512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: