Provider Demographics
NPI:1811303282
Name:GRUBER, JESSICA HEWETSON (BCBA-D, PHD, LBA)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:HEWETSON
Last Name:GRUBER
Suffix:
Gender:F
Credentials:BCBA-D, PHD, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8609 W BRYN MAWR AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3524
Mailing Address - Country:US
Mailing Address - Phone:708-306-2744
Mailing Address - Fax:224-241-3132
Practice Address - Street 1:2701 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3919
Practice Address - Country:US
Practice Address - Phone:224-258-2570
Practice Address - Fax:224-241-3132
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152000103103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst