| Doctor Name: | MS. CONNIE ANN GRAND |
| NPI Number: | 1841490323 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICENSED PROFESSIONA |
| License Number: | 2002032332 |
| Business Practice Address: | 202-1 Nw 11th St Ava, MO - 656089731 |
| Business Phone Number: | 4176834505 |
| Business Fax Number: | 4176834505 |
| Mailing Address: | Route 1, Box 408 AVA |
| State: | MO |
| Postal Code: | 656089731 |
| Phone Number: | 4176831162 |
| Fax Number: | |
| NPI Enumeration Date: | 07/23/2007 |
| NPI Last Update Date: | 07/23/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2002032332 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |