Provider Demographics
NPI:1083758262
Name:ZIEMS, GRANT PAUL (BS, CAC-R)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:PAUL
Last Name:ZIEMS
Suffix:
Gender:M
Credentials:BS, CAC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-9597
Mailing Address - Country:US
Mailing Address - Phone:906-786-9639
Mailing Address - Fax:906-789-8146
Practice Address - Street 1:2920 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-9597
Practice Address - Country:US
Practice Address - Phone:906-786-9639
Practice Address - Fax:906-789-8146
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-00472101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)