Individual
MARK W GRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADCIII
Contact information
Practice address
240 MAPLE STREET, WOODRUFF, WI 54568-0470
(715) 356-8000
Mailing address
240 MAPLE STREET, PO BOX 470, WOODRUFF, WI 54568-0470
(715) 356-8000
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14200
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39333500
—
WI
Enumeration date
10/13/2006
Last updated
07/09/2007
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