Individual
GILLIAN GRANNUM
Active
Individual
GILLIAN GRANNUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PS018690
PA
103TC0700X
Clinical Psychologist
Primary
PS018690
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103573403
—
PA
01
—
14373031
CAQH ID
—
01
—
PS018690
STATE LICENSE - PSYCHOLOGIST
PA
Enumeration date
05/21/2013
Last updated
09/16/2024
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