Provider Demographics
NPI:1629198890
Name:GRUBICH, CLAIRE (LICSW)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:GRUBICH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 HIGHWAY 13 E STE 108
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2877
Mailing Address - Country:US
Mailing Address - Phone:952-564-3000
Mailing Address - Fax:952-564-3031
Practice Address - Street 1:1930 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4708
Practice Address - Country:US
Practice Address - Phone:763-427-7964
Practice Address - Fax:763-427-7976
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1629198890OtherMETROPOLITAN HEALTH PLAN
MN1629198890OtherHEALTH PARTNERS
MN1629198890Medicaid
MN9322OtherTRICARE
MN1629198890OtherBLUE CROSS BLUE SHIELD
MN800002179OtherMEDICARE
MN1629198890OtherBLUE CROSS BLUE SHIELD