Provider Demographics
NPI:1457900177
Name:GRUIDL, MINDY SUE IONE
Entity type:Individual
Prefix:MS
First Name:MINDY
Middle Name:SUE IONE
Last Name:GRUIDL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4965
Mailing Address - Country:US
Mailing Address - Phone:612-232-6902
Mailing Address - Fax:
Practice Address - Street 1:1921 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4965
Practice Address - Country:US
Practice Address - Phone:727-213-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional