Healthcare Provider Details

I. General information

NPI: 1477460673
Provider Name (Legal Business Name): JILLIAN B GRUENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 GRAND AVE
GLENWOOD SPRINGS CO
81601-3842
US

IV. Provider business mailing address

811 GRAND AVE
SILT CO
81652-9316
US

V. Phone/Fax

Practice location:
  • Phone: 970-514-1070
  • Fax: 970-462-9916
Mailing address:
  • Phone: 970-514-1070
  • Fax: 970-462-9916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0024192
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: