MEDICARE: JYOTSNA GRANDHI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	12468-125	WI

General Provider Information

NPI Number	:	1194666750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JYOTSNA GRANDHI

Provider Business Mailing Address
First Line	:	6410 ENTERPRISE LN STE 130
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-1143
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6410 ENTERPRISE LN STE 130
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-1143
Country	:	US
Telephone Number	:	608-590-3885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/09/2026

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Directions to “ JYOTSNA GRANDHI ” Practice Location

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