Provider Demographics
NPI:1982480513
Name:GRIJALVA, GABRIELA (LSW)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:GRIJALVA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 W STIMSON AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2647
Mailing Address - Country:US
Mailing Address - Phone:740-591-0492
Mailing Address - Fax:
Practice Address - Street 1:8 W STIMSON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2647
Practice Address - Country:US
Practice Address - Phone:740-591-0492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2107016104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker