Individual
COURTNEY C GRODIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
12349 DE PAUL DR, BRIDGETON, MO 63044-2512
(314) 291-7900
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-0001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2013016467
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2013016467
LICENSE #
MO
Enumeration date
07/08/2013
Last updated
10/22/2020
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