Provider Demographics
NPI:1679742100
Name:GRUBER, AMY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:GRUBER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 NE 129TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-3236
Mailing Address - Country:US
Mailing Address - Phone:510-915-4014
Mailing Address - Fax:
Practice Address - Street 1:2312 NE 129TH ST STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3236
Practice Address - Country:US
Practice Address - Phone:360-546-5900
Practice Address - Fax:360-546-8090
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
WAPY60932600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist