Individual
KELLY GRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, APSW
Contact information
Practice address
121 W MAIN ST, PORT WASHINGTON, WI 53074-1813
(262) 284-8395
(262) 284-8104
Mailing address
121 W MAIN ST, PORT WASHINGTON, WI 53074-1813
(262) 284-8395
(262) 284-8104
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
126700
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126700
WI LICENSE
WI
Enumeration date
10/14/2014
Last updated
10/14/2014
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