Individual
MS. LEIGH KAROLE GRANNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., BCBA
Contact information
Practice address
625 WHAM DR - MAILCODE 6607, CENTER FOR AUTISM SPECTRUM DISORDERS, CARBONDALE, IL 62901-4313
(618) 453-7168
Mailing address
60 JAROS LN, APT F, MAKANDA, IL 62958-2154
(618) 967-8859
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-04-1782
—
171000000X
Military Health Care Provider
—
—
Other
Enumeration date
03/29/2007
Last updated
11/27/2012
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