Individual
GRANT SOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13603 80TH CIR N, MAPLE GROVE, MN 55369-8961
(763) 274-3120
(763) 274-3121
Mailing address
1900 SILVER LAKE RD NW STE 110, NEW BRIGHTON, MN 55112-1789
(651) 628-9566
(651) 628-0411
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/26/2019
Last updated
08/26/2019
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