Healthcare Provider Details

I. General information

NPI: 1356276729
Provider Name (Legal Business Name): LYDIA KATHRYN GRENKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E MONUMENT ST
COLORADO SPRINGS CO
80903-1018
US

IV. Provider business mailing address

1420 AUSTIN BLUFFS PKWY
COLORADO SPRINGS CO
80918-3735
US

V. Phone/Fax

Practice location:
  • Phone: 719-318-7459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: