Individual
SHAQUILLE GRANT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
804 KELLOGG AVE, AMES, IA 50010-6234
(515) 233-4931
Mailing address
420 KELLOGG AVE, AMES, IA 50010-6226
(515) 233-3141
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
TX
Other
Enumeration date
05/24/2017
Last updated
02/02/2026
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