Provider Demographics
NPI:1073095477
Name:MCGEE-GRANT, PENNY
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:MCGEE-GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 17TH STREET PL SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-1393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5219 N SHIRLEY ST STE 2
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:WA
Practice Address - Zip Code:98407-6599
Practice Address - Country:US
Practice Address - Phone:253-507-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician