MEDICARE: SUE GRANGER LCSW

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	1041C0700X	Clinical Social Worker	2005008067	MO

General Provider Information

NPI Number	:	1518943638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE GRANGER LCSW

Provider Business Mailing Address
First Line	:	314 E MCPHERSON ST
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-3557
Country	:	US
Telephone Number	:	660-627-5757
Fax Number	:	660-627-5802

Provider Business Practice Location Address
First Line	:	502 ROSEWOOD DR
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-2437
Country	:	US
Telephone Number	:	660-627-3621
Fax Number	:	660-627-5798

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	10/26/2007

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Directions to “ SUE GRANGER LCSW” Practice Location

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