Provider Demographics
NPI:1558015164
Name:KAREN GRUMME RODRIGUEZ LLC
Entity Type:Organization
Organization Name:KAREN GRUMME RODRIGUEZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GRUMME RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:479-408-3331
Mailing Address - Street 1:3755 LAURAL RDG
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-1086
Mailing Address - Country:US
Mailing Address - Phone:704-301-4174
Mailing Address - Fax:
Practice Address - Street 1:26 E MEADOW ST STE 14
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5357
Practice Address - Country:US
Practice Address - Phone:479-408-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty