Individual
JILL MARIE GRANILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PLADC
Contact information
Practice address
1941 S 42ND ST, OMAHA, NE 68105-2939
(402) 504-3242
(402) 504-3882
Mailing address
2470 S 5TH ST, OMAHA, NE 68108-1719
(531) 365-1179
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
P-1838
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8606376677
—
NE
Enumeration date
03/14/2022
Last updated
03/14/2022
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