Healthcare Provider Details

I. General information

NPI: 1922987486
Provider Name (Legal Business Name): MRS. JAIME LEIGH GRUBB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 BLACKLICK EASTERN RD
PICKERINGTON OH
43147-8235
US

IV. Provider business mailing address

110 SOUTH CT
EATON OH
45320-2343
US

V. Phone/Fax

Practice location:
  • Phone: 614-726-7359
  • Fax:
Mailing address:
  • Phone: 937-300-9586
  • Fax: 937-300-9586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: