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Individual

JACLYN GRAD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
3851 ROGER BROOKE DR, MCHEQD, FORT SAM HOUSTON, TX 78234-4501
(210) 916-2460
Mailing address
PO BOX 280148, JACKSONVILLE, FL 32228-0148
(904) 270-4338

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
001304
IA

Other

Enumeration date
09/12/2011
Last updated
02/19/2014
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