MEDICARE: DR. JENNIFER GRUBLER PH.D.

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
1	103TC0700X	Clinical Psychologist	0810003804	VA

General Provider Information

NPI Number	:	1467678144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER GRUBLER PH.D.

Provider Business Mailing Address
First Line	:	8550 TIDEWATER DR APT J1
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-5583
Country	:	US
Telephone Number	:	757-233-8585
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 TIDEWATER DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-3300
Country	:	US
Telephone Number	:	757-248-1914
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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