Provider Demographics
NPI:1700214699
Name:MCGRUDER, MICHELLE (DSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:MCGRUDER
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MCGRUDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR MICHELLE MCGRUDER
Mailing Address - Street 1:310 25TH AVE N # 109
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1515
Mailing Address - Country:US
Mailing Address - Phone:615-999-0515
Mailing Address - Fax:
Practice Address - Street 1:310 25TH AVE N STE 204
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2492
Practice Address - Country:US
Practice Address - Phone:615-999-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical