Basic Information
| Provider Information | |||||||||
| NPI: | 1659741841 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRABOUSKI | ||||||||
| FirstName: | JACQUELIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA,NCC,LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 PIERCE ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511051418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122550204 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1221 PIERCE ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511051418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122550204 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 09/30/2015 | ||||||||
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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 | 101YM0800X | 080069 | IA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.