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General NPI Number Information
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NPI Number | 1972923373
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Entity Type | Individual
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Provider Name | CIA GRONNEBERG
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Gender | Female
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Dates
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Enumeration Date | 04/24/2014
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 912 BURREL AVE SE BOX 567
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City | COOPERSTOWN
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State | ND
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Zip | 58425-0567
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Country | US
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Telephone | 701-797-2127
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Fax | 701-797-2172
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Provider Business Mailing Address
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Address Line | BOX 567 912 BURREL AVE SE
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City | COOPERSTOWN
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State | ND
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Zip | 58425-0567
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Country | US
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Telephone | 701-797-2127
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Fax | 701-797-2172
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 3023
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License Number State | ND
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