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General NPI Number Information
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NPI Number | 1235007691
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Entity Type | Individual
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Provider Name | EMILY GRANNEMANN
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Gender | Female
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 2620 FORUM BLVD STE E
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City | COLUMBIA
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State | MO
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Zip | 65203-5454
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Country | US
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Telephone | 573-514-8735
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 FORUM BLVD STE 7A
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City | COLUMBIA
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State | MO
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Zip | 65203-1997
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Country | US
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Telephone | 573-446-0447
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | MO
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