Provider Demographics
NPI:1538055272
Name:GRUGAL, KEISHA
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:GRUGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-3096
Mailing Address - Country:US
Mailing Address - Phone:608-580-0031
Mailing Address - Fax:608-580-0038
Practice Address - Street 1:111 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-3096
Practice Address - Country:US
Practice Address - Phone:608-580-0031
Practice Address - Fax:608-580-0038
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker