Provider Demographics
NPI:1548896947
Name:GRABER, JESSICA (PHD, BCBA-D, COBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GRABER
Suffix:
Gender:
Credentials:PHD, BCBA-D, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 BLAZER PARKWAY STE 137
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3562
Mailing Address - Country:US
Mailing Address - Phone:614-877-6129
Mailing Address - Fax:
Practice Address - Street 1:5650 BLAZER PARKWAY STE 137
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3562
Practice Address - Country:US
Practice Address - Phone:614-877-6129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3151103K00000X
TX37954103T00000X
OHP.08421103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical