Basic Information
| Provider Information | |||||||||
| NPI: | 1033413646 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRUBA | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MS, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 710 N. WEBB AVE | ||||||||
| Address2: | |||||||||
| City: | REEDSBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6085245151 | ||||||||
| FaxNumber: | 6085245353 | ||||||||
| Practice Location | |||||||||
| Address1: | 706 WILLIAMSON ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537034658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082645342 | ||||||||
| FaxNumber: | 6082645344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2010 | ||||||||
| LastUpdateDate: | 06/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 867-124 | WI | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.