Individual
PAUL GRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
121 W MAIN ST, PORT WASHINGTON, WI 53074-1813
(262) 284-8200
(282) 284-8104
Mailing address
121 W MAIN ST, PORT WASHINGTON, WI 53074-1813
(262) 284-8200
(282) 284-8104
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
807123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39240800
—
WI
Enumeration date
10/31/2005
Last updated
10/27/2014
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