Provider Demographics
NPI:1770969305
Name:GRODZKI, ALLISON R (PSYD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:R
Last Name:GRODZKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:
Other - Last Name:DERANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3585 FALCON WAY
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4880
Mailing Address - Country:US
Mailing Address - Phone:701-388-7490
Mailing Address - Fax:
Practice Address - Street 1:26010 OAK RIDGE DR STE 107
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1972
Practice Address - Country:US
Practice Address - Phone:281-815-0899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5014103TC0700X
TX38916103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical