Provider Demographics
NPI:1669801114
Name:GRUNDTNER, KRYSTLYNN (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:KRYSTLYNN
Middle Name:
Last Name:GRUNDTNER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:KRYSTLYNN
Other - Middle Name:ANNE
Other - Last Name:CUMISKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8400 E YALE AVE APT 2-308
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3853
Mailing Address - Country:US
Mailing Address - Phone:651-271-0032
Mailing Address - Fax:651-379-1738
Practice Address - Street 1:8400 E YALE AVE APT 2-308
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-3853
Practice Address - Country:US
Practice Address - Phone:651-271-0032
Practice Address - Fax:651-379-1738
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN203881041C0700X
CO099278341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical