Individual
DR. DIANNE L GRANDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
335 N RIVER ST, SUITE 210, BATAVIA, IL 60510-2386
(630) 406-5493
(630) 879-6806
Mailing address
516 WEST LANE, GENEVA, IL 60134-1037
(630) 208-1975
(630) 879-6806
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-004183
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2619
MEDICARE PTAN
IL
Enumeration date
08/30/2006
Last updated
09/29/2016
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