Provider Demographics
NPI:1598505166
Name:GRYGLESKI, PHILIP (MS)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:GRYGLESKI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233A BUSINESS PARK DR STE 304
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54482-8861
Mailing Address - Country:US
Mailing Address - Phone:800-681-2374
Mailing Address - Fax:715-952-4995
Practice Address - Street 1:3233A BUSINESS PARK DR STE 304
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8861
Practice Address - Country:US
Practice Address - Phone:800-681-2374
Practice Address - Fax:715-952-4995
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7853-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional