Individual
MS. RAEVEN GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8946 INTERLINE AVE STE A, BATON ROUGE, LA 70809-1913
(225) 615-7282
Mailing address
416 SKIPPER ST, BREAUX BRIDGE, LA 70517-6018
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/28/2016
Last updated
09/28/2016
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