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NPI Code Detail

MEDICARE: KELLY R GRUBBS LISW

MEDICARE: KELLY R GRUBBS LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI.0009168OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184814063
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY R GRUBBS LISW
Provider Business Mailing Address
First Line : 4760 MADISON RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45227-1426
Country : US
Telephone Number : 513-321-8286
Fax Number : 513-533-5828
Provider Business Practice Location Address
First Line : 4760 MADISON RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45227-1426
Country : US
Telephone Number : 513-321-8286
Fax Number : 513-533-5828
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2007
Last Update Date : 07/27/2007

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