Individual
MARY GRUBB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
1901 OLDS CT, KOKOMO, IN 46902-2529
(765) 453-8547
Mailing address
1901 OLDS CT, KOKOMO, IN 46902-2529
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
33006027A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33006027A
LSW
IN
Enumeration date
11/28/2013
Last updated
11/11/2015
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