Provider Demographics
NPI:1174638522
Name:GRONSETH, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GRONSETH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 41ST AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1622
Mailing Address - Country:US
Mailing Address - Phone:206-721-7219
Mailing Address - Fax:
Practice Address - Street 1:V A PUGET SOUND HEALTH CARE SYSTEM / AMERICAN LK
Practice Address - Street 2:A 116-ICM
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0001
Practice Address - Country:US
Practice Address - Phone:253-582-8440
Practice Address - Fax:253-589-4087
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000077521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical