Individual
GRACE R JASIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1275
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320474
—
AZ
01
—
AZ0138740
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
11/01/2006
Last updated
06/26/2024
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