Individual
STACY GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
415 S 42ND ST, APT 4, PHILADELPHIA, PA 19104-4094
(570) 977-0646
Mailing address
415 S 42ND ST, APT 4, PHILADELPHIA, PA 19104-4094
(570) 977-0646
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
OC012558
PA
Other
Enumeration date
03/22/2016
Last updated
10/17/2016
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