Provider Demographics
NPI:1013199629
Name:GRANDE, ELIZABETH IBONNE (MA , RC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:IBONNE
Last Name:GRANDE
Suffix:
Gender:F
Credentials:MA , RC
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Mailing Address - Street 1:2101 E YESLER WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5959
Mailing Address - Country:US
Mailing Address - Phone:206-299-1900
Mailing Address - Fax:206-299-1920
Practice Address - Street 1:2101 E YESLER WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5959
Practice Address - Country:US
Practice Address - Phone:206-299-1900
Practice Address - Fax:206-299-1920
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WARC00023347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health