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General NPI Number Information
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NPI Number | 1679395883
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Entity Type | Individual
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Provider Name | JACLYN GRELLE ED.S.
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Gender | Female
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 6740 W MORRIS ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46241-1719
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Country | US
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Telephone | 317-988-8082
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Fax |
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Provider Business Mailing Address
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Address Line | 6861 WALNUT BEND RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-5233
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Country | US
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Telephone | 317-650-2263
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 10140084
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License Number State | IN
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