Provider Demographics
NPI:1780259036
Name:GRONAUER, KAITLYN MARGARET
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARGARET
Last Name:GRONAUER
Suffix:
Gender:F
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PRISMA HEALTH MEDICAL GROUP GENERAL PSYCHIATRY
Mailing Address - Street 2:15 MEDICAL PARK, SUITE 141
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-4300
Mailing Address - Fax:803-434-4062
Practice Address - Street 1:PRISMA HEALTH MEDICAL GROUP GENERAL PSYCHIATRY
Practice Address - Street 2:15 MEDICAL PARK, SUITE 141
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-4300
Practice Address - Fax:803-434-4062
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL861552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry