Healthcare Provider Details

I. General information

NPI: 1053934695
Provider Name (Legal Business Name): JESSICA GRUBB BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 ST JOHN RD STE 50
FLETCHER NC
28732-8334
US

IV. Provider business mailing address

235 ST JOHN RD STE 50
FLETCHER NC
28732-8334
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-1113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1265
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-65279
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: