Provider Demographics
NPI:1518943638
Name:GRANGER, SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:GRANGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:OSBORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:314 E MCPHERSON ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-3557
Mailing Address - Country:US
Mailing Address - Phone:660-627-5757
Mailing Address - Fax:660-627-5802
Practice Address - Street 1:502 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2437
Practice Address - Country:US
Practice Address - Phone:660-627-3621
Practice Address - Fax:660-627-5798
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050080671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical