Individual
DYLAN GRUEBELE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SCHOOL PSYCHOLOGIST
Contact information
Practice address
9275 GLACIER POINT DR, STOCKTON, CA 95212-3494
(209) 953-9601
Mailing address
1305 E VINE ST, LODI, CA 95240-3179
(209) 953-9601
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
210134367
CA
Other
Enumeration date
07/26/2024
Last updated
07/26/2024
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