MEDICARE: DR. STEPHANIE GRANGER PSYD

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	103TC0700X	Clinical Psychologist	2452	KS

General Provider Information

NPI Number	:	1760931703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE GRANGER PSYD

Provider Business Mailing Address
First Line	:	121 S WHITTIER RD # 400
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67207-1064
Country	:	US
Telephone Number	:	513-502-6215
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 S WHITTIER RD # 400
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67207-1064
Country	:	US
Telephone Number	:	513-502-6215
Fax Number	:	785-246-8232

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

Provider Enumeration Date	:	10/03/2016
Last Update Date	:	12/20/2025

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