Healthcare Provider Details

I. General information

NPI: 1003462235
Provider Name (Legal Business Name): GENEVIEVE M GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 W 26TH AVE STE 217
DENVER CO
80211-5308
US

IV. Provider business mailing address

PO BOX 639561
CINCINNATI OH
45263-9561
US

V. Phone/Fax

Practice location:
  • Phone: 303-322-7108
  • Fax:
Mailing address:
  • Phone: 847-807-3917
  • Fax: 847-348-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12473117
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: