Healthcare Provider Details

I. General information

NPI: 1093086803
Provider Name (Legal Business Name): STEPHANIE A GRZYBEK L.I.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 KIMBALL AVE STE 101
WATERLOO IA
50702-5047
US

IV. Provider business mailing address

3421 W 9TH ST
WATERLOO IA
50702-5401
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-2112
  • Fax: 319-272-2107
Mailing address:
  • Phone: 319-272-7304
  • Fax: 319-272-7318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007231
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: