Provider Demographics
NPI:1861627325
Name:AHERN-GRUNDLAND, ADRIANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANNE
Middle Name:
Last Name:AHERN-GRUNDLAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ADRIANNE
Other - Middle Name:
Other - Last Name:AHERN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:11622 EL CAMINO REAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2049
Mailing Address - Country:US
Mailing Address - Phone:858-784-1312
Mailing Address - Fax:858-764-2501
Practice Address - Street 1:11622 EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2049
Practice Address - Country:US
Practice Address - Phone:858-784-1312
Practice Address - Fax:858-764-2501
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14473103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral