Provider Demographics
NPI:1043040595
Name:GRUELL, KATELYN NICOLE
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:NICOLE
Last Name:GRUELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9371 WHISTLE STOP PL APT C3322
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-1162
Mailing Address - Country:US
Mailing Address - Phone:414-530-9870
Mailing Address - Fax:
Practice Address - Street 1:4060 EMERALD DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2579
Practice Address - Country:US
Practice Address - Phone:972-882-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122763235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist