MEDICARE: MS. MINDY SUE IONE GRUIDL

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
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1457900177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MINDY SUE IONE GRUIDL

Provider Business Mailing Address
First Line	:	1921 CARLISLE BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4965
Country	:	US
Telephone Number	:	612-232-6902
Fax Number	:

Provider Business Practice Location Address
First Line	:	1921 CARLISLE BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4965
Country	:	US
Telephone Number	:	727-213-8850
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	12/02/2025

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