Provider Demographics
NPI:1356704530
Name:GROEHN, CRAIG
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:GROEHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-2969
Mailing Address - Country:US
Mailing Address - Phone:515-432-7288
Mailing Address - Fax:515-432-7289
Practice Address - Street 1:610 10TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-2221
Practice Address - Country:US
Practice Address - Phone:515-465-7541
Practice Address - Fax:515-465-7636
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical