Provider Demographics
NPI:1407120173
Name:GRUDZIELANEK, BRIA LYNN (MSW)
Entity Type:Individual
Prefix:
First Name:BRIA
Middle Name:LYNN
Last Name:GRUDZIELANEK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 TRANSFER RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1404
Mailing Address - Country:US
Mailing Address - Phone:651-659-2900
Mailing Address - Fax:651-645-7307
Practice Address - Street 1:762 TRANSFER RD
Practice Address - Street 2:SUITE 21
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1404
Practice Address - Country:US
Practice Address - Phone:651-659-2900
Practice Address - Fax:651-645-7307
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN176231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical