Healthcare Provider Details

I. General information

NPI: 1588527410
Provider Name (Legal Business Name): MR. JACOB GRAPPIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34159 JEFFERSON AVE
SAINT CLAIR SHORES MI
48082-1190
US

IV. Provider business mailing address

1893 HICKORY LN APT 203
IMLAY CITY MI
48444-8528
US

V. Phone/Fax

Practice location:
  • Phone: 596-220-2420
  • Fax:
Mailing address:
  • Phone: 810-322-9451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1467554
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: