Individual
JEANETTE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
300 COLORADO AVE, PUEBLO, CO 81004-2006
(719) 543-8711
Mailing address
110 E ROUTT AVE, PUEBLO, CO 81004-2117
(719) 543-8718
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
992832
CO
Other
Enumeration date
12/27/2011
Last updated
05/24/2012
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