Individual
GRACE GRAMBORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-IT, SAC-IT
Contact information
Practice address
3610 OAKWOOD MALL DR STE 104, EAU CLAIRE, WI 54701-9084
(715) 246-4840
Mailing address
3610 OAKWOOD MALL DR STE 104, EAU CLAIRE, WI 54701-9084
(715) 246-4840
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
19134-130
WI
101YP2500X
Professional Counselor
Primary
4599-226
WI
Other
Enumeration date
10/06/2020
Last updated
11/05/2020
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