Individual
JHONNY D GRADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5839 N TEUTONIA AVE, MILWAUKEE, WI 53209-4161
(917) 719-4698
Mailing address
5839 N TEUTONIA AVE, MILWAUKEE, WI 53209-4161
(917) 719-4698
Taxonomy
Speciality
Code
Description
License number
State
101200000X
Drama Therapist
Primary
G6304246825900
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G6304246825900
—
WI
Enumeration date
08/26/2021
Last updated
08/26/2021
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