Provider Demographics
NPI:1376106294
Name:GRAJEWSKI, JACLYN ANN
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:ANN
Last Name:GRAJEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:ANN
Other - Last Name:NIEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 W BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3202
Mailing Address - Country:US
Mailing Address - Phone:480-684-8345
Mailing Address - Fax:
Practice Address - Street 1:525 W BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3202
Practice Address - Country:US
Practice Address - Phone:480-684-8345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-16046104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker