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Contact Information

KENNETH L GRIZZLE, PHD
13800 W NORTH AVE
CHILD DEVELOPMENT CENTER OF CHW
BROOKFIELD, WI53005-4977
 Phone: 262-432-6600
 Fax: 262-432-6604
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical Child & Adolescent

103TC2200X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for KENNETH L GRIZZLE · (Male)

NPI # 1912958737
Status Active
Credentials PHD
Entity Individual
Enumeration date 05/15/2006
Last updated 11/21/2013 - About 13 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 2187
  • WI Medicaid 1912958737
  • Other 005000215G HUMANA
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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