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General NPI Number Information
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NPI Number | 1104958123
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Entity Type | Individual
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Provider Name | GEORGIA GRUSING MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3900 E MEXICO AVE STE 612
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City | DENVER
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State | CO
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Zip | 80210-3943
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Country | US
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Telephone | 303-691-2635
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Fax |
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Provider Business Mailing Address
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Address Line | 7992 S VINCENNES WAY
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City | CENTENNIAL
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State | CO
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Zip | 80112-3333
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Country | US
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Telephone | 303-773-3293
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 986055
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License Number State | CO
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