Provider Demographics
NPI:1497173264
Name:GRUEN, ANDREW KARL
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:KARL
Last Name:GRUEN
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 1:1551 MERCER ST
Mailing Address - Street 2:
Mailing Address - City:LUPTON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37351-0439
Mailing Address - Country:US
Mailing Address - Phone:423-580-5557
Mailing Address - Fax:877-208-5074
Practice Address - Street 1:1551 MERCER ST
Practice Address - Street 2:
Practice Address - City:LUPTON CITY
Practice Address - State:TN
Practice Address - Zip Code:37351-0439
Practice Address - Country:US
Practice Address - Phone:423-580-5557
Practice Address - Fax:877-208-5074
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist