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General NPI Number Information
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NPI Number | 1588523872
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Entity Type | Individual
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Provider Name | JALEN D GRISSOM
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Gender |
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 982 ARTESIA BLVD
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2707
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Country | US
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Telephone | 310-893-3471
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 REDWOOD WAY STE 210
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City | PETALUMA
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State | CA
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Zip | 94954-1134
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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