Provider Demographics
NPI:1962939207
Name:GRIESE, JACQUELINE OLIVEIRA
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:OLIVEIRA
Last Name:GRIESE
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 1:335 BENT CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4877
Mailing Address - Country:US
Mailing Address - Phone:386-868-9516
Mailing Address - Fax:
Practice Address - Street 1:335 BENT CREEK LN
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4877
Practice Address - Country:US
Practice Address - Phone:386-868-9516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst