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General NPI Number Information
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NPI Number | 1730840752
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Entity Type | Individual
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Provider Name | HANNAH BEATRICE GRUNDVIG
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Gender | Female
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Dates
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Enumeration Date | 01/02/2022
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Last Update Date | 01/02/2022
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Provider Practice Location Address
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Address Line | 3355 N UNIVERSITY AVE STE 250
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City | PROVO
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State | UT
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Zip | 84604-6640
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Country | US
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Telephone | 801-341-9066
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Fax |
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Provider Business Mailing Address
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Address Line | 80 W 880 N APT 6
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City | PROVO
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State | UT
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Zip | 84604-5170
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Country | US
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Telephone | 408-460-3575
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 12436087-3904
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License Number State | UT
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