Provider Demographics
NPI:1619150372
Name:GRIBBIN, DEE (MS)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:
Last Name:GRIBBIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 WILLAMETTE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4093
Mailing Address - Country:US
Mailing Address - Phone:541-341-6282
Mailing Address - Fax:
Practice Address - Street 1:1524 WILLAMETTE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4093
Practice Address - Country:US
Practice Address - Phone:541-341-6282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5045103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist