Provider Demographics
NPI:1497835532
Name:GRUBB, GAIL DIVIZIO (MA/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:DIVIZIO
Last Name:GRUBB
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11260 CLEMENTOWN RD
Mailing Address - Street 2:
Mailing Address - City:AMELIA COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23002-5131
Mailing Address - Country:US
Mailing Address - Phone:804-561-0183
Mailing Address - Fax:
Practice Address - Street 1:2925 POLO PKWY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-1453
Practice Address - Country:US
Practice Address - Phone:804-323-9060
Practice Address - Fax:804-323-7576
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist