Provider Demographics
NPI:1467019513
Name:GRANT, VICKIE A (EDD)
Entity Type:Individual
Prefix:DR
First Name:VICKIE
Middle Name:A
Last Name:GRANT
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:NE
Mailing Address - Zip Code:69343-1023
Mailing Address - Country:US
Mailing Address - Phone:605-685-8896
Mailing Address - Fax:
Practice Address - Street 1:1604 SWEETWATER AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-2672
Practice Address - Country:US
Practice Address - Phone:308-762-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional