Individual
PAUL GRONNEBERG
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.A., L.P.
Contact information
Practice address
730 S FRONT ST, MANKATO, MN 56001-3803
(507) 387-3777
(507) 344-1726
Mailing address
730 S FRONT ST, MANKATO, MN 56001-3803
(507) 387-3777
(507) 344-1726
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP0728
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115278
UCARE
MN
01
—
33P34GR
BLUE CROSS BLUE SHIELD
MN
01
—
6162711
UNITED BEHAVIORAL HEALTH
MN
Enumeration date
07/18/2005
Last updated
07/08/2007
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