Provider Demographics
NPI:1942184999
Name:GRUBOWSKI, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GRUBOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 DOVER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8995
Mailing Address - Country:US
Mailing Address - Phone:904-314-1107
Mailing Address - Fax:
Practice Address - Street 1:200 CLUBHOUSE VISTA RD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:FL
Practice Address - Zip Code:32702-9639
Practice Address - Country:US
Practice Address - Phone:800-343-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA22481235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist