Provider Demographics
NPI:1073330775
Name:GRUMAN, KALLIE
Entity type:Individual
Prefix:
First Name:KALLIE
Middle Name:
Last Name:GRUMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 2ND AVE NE STE 101
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-3060
Mailing Address - Country:US
Mailing Address - Phone:701-845-8518
Mailing Address - Fax:
Practice Address - Street 1:415 2ND AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3060
Practice Address - Country:US
Practice Address - Phone:701-845-8518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver
No175T00000XOther Service ProvidersPeer Specialist