Provider Demographics
NPI:1215691829
Name:GRUVER, JAZLYN JEAN
Entity type:Individual
Prefix:
First Name:JAZLYN
Middle Name:JEAN
Last Name:GRUVER
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 1:207 S DUFFY RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2708
Mailing Address - Country:US
Mailing Address - Phone:724-355-8614
Mailing Address - Fax:
Practice Address - Street 1:349 N MCKEAN ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4928
Practice Address - Country:US
Practice Address - Phone:724-282-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional