Healthcare Provider Details

I. General information

NPI: 1548896947
Provider Name (Legal Business Name): JESSICA GRABER PHD, BCBA-D, COBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 BLAZER PARKWAY STE 137
DUBLIN OH
43017-3562
US

IV. Provider business mailing address

5650 BLAZER PARKWAY STE 137
DUBLIN OH
43017-3562
US

V. Phone/Fax

Practice location:
  • Phone: 614-877-6129
  • Fax:
Mailing address:
  • Phone: 614-877-6129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number37954
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.08421
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberP.08421
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3151
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: