MEDICARE: DR. GEORGE DAVID GRUENDEL PH D

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	103T00000X	Psychologist	4	NE
2	103TA0700X	Adult Development & Aging Psychologist	4	NE
3	103TB0200X	Cognitive & Behavioral Psychologist	4	NE
4	103TC0700X	Clinical Psychologist	4	NE
5	103TE1100X	Exercise & Sports Psychologist	4	NE
6	103TF0000X	Family Psychologist	4	NE
7	103TH0100X	Health Service Psychologist	4	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08013	OTHER	NE	BCBS

General Provider Information

NPI Number	:	1982691960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE DAVID GRUENDEL PH D

Provider Business Mailing Address
First Line	:	908 N HOWARD AVE
Second Line	:	SUITE 107
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-3556
Country	:	US
Telephone Number	:	308-381-2233
Fax Number	:	308-381-2234

Provider Business Practice Location Address
First Line	:	908 N HOWARD AVE
Second Line	:	SUITE 107
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-3556
Country	:	US
Telephone Number	:	308-381-2233
Fax Number	:	308-381-2234

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	09/11/2025

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Directions to “ DR. GEORGE DAVID GRUENDEL PH D” Practice Location

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