Individual
AUDREY GRINNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
37 ANDOVER RD, PORTLAND, ME 04102
(207) 661-6704
Mailing address
37 ANDOVER RD, PORTLAND, ME 04102
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103K00000X
Behavior Analyst
Primary
1-20-40729
ME
Other
Enumeration date
08/21/2017
Last updated
09/21/2021
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