Provider Demographics
NPI:1548806482
Name:GRUENHAGEN, LAUREN ANNE
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ANNE
Last Name:GRUENHAGEN
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 1:2130 8TH ST S
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-3507
Mailing Address - Country:US
Mailing Address - Phone:605-696-4706
Mailing Address - Fax:605-696-4704
Practice Address - Street 1:2130 8TH ST S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-3507
Practice Address - Country:US
Practice Address - Phone:605-696-4706
Practice Address - Fax:605-696-4704
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD73622-2103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool