Provider Demographics
NPI:1982691960
Name:GRUENDEL, GEORGE DAVID (PH D)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DAVID
Last Name:GRUENDEL
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N HOWARD AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3556
Mailing Address - Country:US
Mailing Address - Phone:308-381-2233
Mailing Address - Fax:308-381-2234
Practice Address - Street 1:908 N HOWARD AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3556
Practice Address - Country:US
Practice Address - Phone:308-381-2233
Practice Address - Fax:308-381-2234
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4103T00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TE1100X, 103TF0000X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08013OtherBCBS
094015Medicare ID - Type Unspecified
NE08013OtherBCBS