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General NPI Number Information
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NPI Number | 1629131164
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Entity Type | Individual
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Provider Name | CAROL ANN GRONSETH M.S.,L.P.
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 315 ELTON HILLS DR NW
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City | ROCHESTER
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State | MN
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Zip | 55901-2477
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Country | US
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Telephone | 507-287-7105
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Fax | 507-529-4570
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Provider Business Mailing Address
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Address Line | 5630 COUNTY ROAD 103 NW
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City | BYRON
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State | MN
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Zip | 55920-4105
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Country | US
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Telephone |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP 3678
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License Number State | MN
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