Provider Demographics
NPI:1174325237
Name:KYLEE GRUHLKE, PLLC
Entity type:Organization
Organization Name:KYLEE GRUHLKE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUHLKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:701-935-0869
Mailing Address - Street 1:756 4TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5803
Mailing Address - Country:US
Mailing Address - Phone:701-935-0869
Mailing Address - Fax:701-291-4868
Practice Address - Street 1:2215 SIMS ST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-6521
Practice Address - Country:US
Practice Address - Phone:701-935-0869
Practice Address - Fax:701-291-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health