Provider Demographics
NPI:1700018348
Name:NEIDHARDT-GRUHL, BRITTNEY NEUMAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:BRITTNEY
Middle Name:NEUMAN
Last Name:NEIDHARDT-GRUHL
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:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:911 N 10TH PL
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-0009
Practice Address - Country:US
Practice Address - Phone:206-320-2961
Practice Address - Fax:206-991-2061
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-16
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60736577104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1700018348Medicaid