Provider Demographics
NPI:1144433657
Name:GRUNDY, JODINE M (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:JODINE
Middle Name:M
Last Name:GRUNDY
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3481 MORRISON PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-1530
Mailing Address - Country:US
Mailing Address - Phone:513-751-6115
Mailing Address - Fax:513-751-3131
Practice Address - Street 1:330 W 4TH ST
Practice Address - Street 2:#3
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-2680
Practice Address - Country:US
Practice Address - Phone:513-784-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC-0002677101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional