Individual
DR. NICOLE PAIGE GRUNZKE-LYNNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D., L.P.
Contact information
Practice address
2388 UNIVERSITY AVE W, #207, SAINT PAUL, MN 55114-1769
(952) 210-1360
Mailing address
8855 RIVER HEIGHTS WAY, INVER GROVE HEIGHTS, MN 55076-3479
(651) 554-9407
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4347
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
156M3GR
BCBS
MN
01
—
557344100
MEDICAL ASSISTANCE
MN
01
—
61-42042
UBH
MN
01
—
6142042
STATE TAX ID
MN
Enumeration date
05/30/2006
Last updated
01/09/2013
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