Provider Demographics
NPI:1386278125
Name:GRUEBELE, KIMBERLY SUE
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SUE
Last Name:GRUEBELE
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:EUREKA PUBLIC SCHOOL
Mailing Address - Street 2:PO BOX 10, 805 10TH ST
Mailing Address - City:EUREKA
Mailing Address - State:SD
Mailing Address - Zip Code:57437
Mailing Address - Country:US
Mailing Address - Phone:605-284-2875
Mailing Address - Fax:
Practice Address - Street 1:EUREKA PUBLIC SCHOOL
Practice Address - Street 2:805 10TH ST
Practice Address - City:EUREKA
Practice Address - State:SD
Practice Address - Zip Code:57437
Practice Address - Country:US
Practice Address - Phone:605-284-2875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD092-LIMITED235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist