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NPI Code Detail

MEDICARE: OLGA GRUN PHD, LP

MEDICARE:   OLGA  GRUN  PHD, LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist4405MN

General Provider Information

NPI Number : 1649378316
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLGA GRUN PHD, LP
Provider Business Mailing Address
First Line : 3108 HENNEPIN AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-2619
Country : US
Telephone Number : 612-825-4407
Fax Number : 612-825-0768
Provider Business Practice Location Address
First Line : 3108 HENNEPIN AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-2619
Country : US
Telephone Number : 612-825-4407
Fax Number : 612-825-0768
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/08/2007

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Directions to “ OLGA GRUN PHD, LP” Practice Location

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