Healthcare Provider Details

I. General information

NPI: 1356704530
Provider Name (Legal Business Name): CRAIG GROEHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 10TH ST
PERRY IA
50220-2221
US

IV. Provider business mailing address

927 8TH ST
BOONE IA
50036-2969
US

V. Phone/Fax

Practice location:
  • Phone: 515-465-7541
  • Fax: 515-465-7636
Mailing address:
  • Phone: 515-432-7288
  • Fax: 515-432-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00800
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: