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NPI Code Detail

MEDICARE: JODI GRUENDLER CADC

MEDICARE: JODI GRUENDLER CADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111540042OTHERIDIDAHO BOARD OF ALCOHOL/DRUG COUNSELOR CERTIFICATION

General Provider Information

NPI Number : 1417404757
Entity Type Code : Individual
Provider Name (Legal Business Name) : JODI GRUENDLER CADC
Provider Business Mailing Address
First Line : 219 GOODING ST N
Second Line :
City : TWIN FALLS
State : ID
Zip : 83301-6178
Country : US
Telephone Number : 208-734-5230
Fax Number : 208-732-5894
Provider Business Practice Location Address
First Line : 219 GOODING ST N
Second Line :
City : TWIN FALLS
State : ID
Zip : 83301-6178
Country : US
Telephone Number : 208-734-5230
Fax Number : 208-732-5894
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2016
Last Update Date : 09/02/2016

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Directions to “ JODI GRUENDLER CADC” Practice Location

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