1669801114 NPI number — KRYSTLYNN GRUNDTNER MSW, LICSW

Table of content: KRYSTLYNN GRUNDTNER MSW, LICSW (NPI 1669801114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669801114 NPI number — KRYSTLYNN GRUNDTNER MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRUNDTNER
Provider First Name:
KRYSTLYNN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CUMISKEY
Provider Other First Name:
KRYSTLYNN
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669801114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8400 E YALE AVE APT 2-308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80231-3853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-271-0032
Provider Business Mailing Address Fax Number:
651-379-1738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8400 E YALE AVE APT 2-308
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80231-3853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-271-0032
Provider Business Practice Location Address Fax Number:
651-379-1738
Provider Enumeration Date:
11/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  20388 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 09927834 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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