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General NPI Number Information
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NPI Number | 1912568528
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Entity Type | Individual
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Provider Name | JENNIFER GRANT
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Gender | Female
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 1040 W BRISTOL RD
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City | FLINT
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State | MI
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Zip | 48507-5516
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Country | US
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Telephone | 810-496-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 9476 SUNRISE LN
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City | DAVISON
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State | MI
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Zip | 48423-8468
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801111087
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License Number State | MI
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