Individual
MISS LAYNE NICOLE GRISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
425 BROADWAY ST, PADUCAH, KY 42001-0713
(270) 444-3604
Mailing address
425 BROADWAY ST, PADUCAH, KY 42001-0713
(270) 444-3604
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
08/15/2018
Last updated
08/15/2018
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