Provider Demographics
NPI:1083019566
Name:GRONEWOLD, JILL DANIELLE
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:DANIELLE
Last Name:GRONEWOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-9640
Mailing Address - Country:US
Mailing Address - Phone:641-780-8254
Mailing Address - Fax:
Practice Address - Street 1:909 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-2743
Practice Address - Country:US
Practice Address - Phone:641-842-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health