Healthcare Provider Details

I. General information

NPI: 1457266579
Provider Name (Legal Business Name): KAITLYN GRENZ M.S.ED, ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 CENTER RD
NOVATO CA
94947-2975
US

IV. Provider business mailing address

1800 CENTER RD
NOVATO CA
94947-2975
US

V. Phone/Fax

Practice location:
  • Phone: 415-493-4346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: