Doctor Name: | JEANETTE GRANSTROM |
NPI Number: | 1891151361 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | AA, BA, MACP |
License Number: | CG 60151269 |
Business Practice Address: | 4047 Heritage Ave E Fife, WA - 984243798 |
Business Phone Number: | 2532598645 |
Business Fax Number: | |
Mailing Address: | 4047 Heritage Ave E, FIFE |
State: | WA |
Postal Code: | 984243798 |
Phone Number: | 2532598645 |
Fax Number: | |
NPI Enumeration Date: | 01/13/2016 |
NPI Last Update Date: | 01/13/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | CG 60151269 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |