Provider Demographics
NPI:1174766810
Name:GRZYBOWSKI, JESSICA A (MS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:GRZYBOWSKI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:WEHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:CLINCAL CANCER CENTER, QUALITY OF LIFE CLINIC
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-9087
Mailing Address - Fax:414-805-0970
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:CLINCAL CANCER CENTER, QUALITY OF LIFE CLINIC
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-9087
Practice Address - Fax:414-805-0970
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL247000012170300000X
WI170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS