Individual
DR. GRADY K BACCUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2021 E DUBLIN GRANVILLE RD, SUITE 169, COLUMBUS, OH 43229-3568
(614) 888-5133
(614) 888-8331
Mailing address
2021 E DUBLIN GRANVILLE RD, SUITE 169, COLUMBUS, OH 43229-3568
(614) 888-5133
(614) 888-8331
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4269
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0819547
—
OH
Enumeration date
09/23/2006
Last updated
07/09/2007
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