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General NPI Number Information
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NPI Number | 1518943638
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Entity Type | Individual
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Provider Name | SUE GRANGER LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 502 ROSEWOOD DR
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City | KIRKSVILLE
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State | MO
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Zip | 63501-2437
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Country | US
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Telephone | 660-627-3621
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Fax | 660-627-5798
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Provider Business Mailing Address
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Address Line | 314 E MCPHERSON ST
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City | KIRKSVILLE
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State | MO
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Zip | 63501-3557
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Country | US
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Telephone | 660-627-5757
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Fax | 660-627-5802
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2005008067
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License Number State | MO
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