Individual
DR. KENNETH L GRIZZLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
13800 W NORTH AVE, CHILD DEVELOPMENT CENTER OF CHW, BROOKFIELD, WI 53005-4977
(262) 432-6600
(262) 432-6604
Mailing address
13800 W NORTH AVE, CHILD DEVELOPMENT CENTER OF CHW, BROOKFIELD, WI 53005-4977
(262) 432-6600
(262) 432-6604
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
2187
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005000215G
HUMANA
—
05
—
1912958737
—
WI
Enumeration date
05/15/2006
Last updated
11/21/2013
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