Individual
RACHEL GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
2330 SIOUX TRL NW, PRIOR LAKE, MN 55372-9077
(952) 496-6164
Mailing address
2330 SIOUX TRL NW, PRIOR LAKE, MN 55372-9077
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
301722
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
301722
LADC LIC
MN
Enumeration date
08/29/2011
Last updated
08/29/2011
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