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DR. KENNETH L GRIZZLE PHD NPI 1912958737


NPI Information

NPI: 1912958737
Provider Name: DR. KENNETH L GRIZZLE, PHD
Classification: Psychologist - 103TC2200X
Entity Type: Individual

Specialization: Clinical Child & Adolescent

PECOS Registration: Yes

Address:
13800 W NORTH AVE
CHILD DEVELOPMENT CENTER OF CHW
BROOKFIELD, WI
ZIP 53005
Phone: (262) 432-6600
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DR. Kenneth L Grizzle, PHD is a clinical child and adolescent psychologist in Brookfield, WI with 31 years of experience. The provider is a psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology is an understanding of the basic psychological needs of children and adolescents, and how the family and other social contexts influence the socio-emotional adjustment, cognitive development, behavioral adaptation and health status of children and adolescents. DR. Kenneth L Grizzle, PHD NPI is 1912958737. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: INDIANA UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:1993

The provider's business location address is:

13800 W NORTH AVE
CHILD DEVELOPMENT CENTER OF CHW
BROOKFIELD, WI
ZIP 53005-977
Phone: (262) 432-6600
Fax: (262) 432-6604

The NPI 1912958737 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 5/15/2006 and was last updated on 11/21/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103TC2200XPsychologistClinical Child & Adolescent2187WISCONSINYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1005000215GOTHERHUMANA
273601 1987MEDICARE PINWISCONSIN
3P15928MEDICARE UPIN
41912958737MEDICAIDWISCONSIN
560255 0087MEDICARE PINWISCONSIN
668086 0733MEDICARE PINWISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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