Individual
TIFFANY ROSE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2705 E 17TH ST, AMMON, ID 83406
(208) 346-7500
(208) 346-7501
Mailing address
2705 E 17TH ST, AMMON, ID 83406-6601
(208) 346-7500
(208) 346-7501
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LCSW-40683
ID
104100000X
Social Worker
—
—
Other
Enumeration date
06/08/2017
Last updated
09/17/2021
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