Provider Demographics
NPI:1568531150
Name:GRADY, JANE G (PHD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:G
Last Name:GRADY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S MERAMEC AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3514
Mailing Address - Country:US
Mailing Address - Phone:314-863-6444
Mailing Address - Fax:314-863-6324
Practice Address - Street 1:222 S MERAMEC AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3514
Practice Address - Country:US
Practice Address - Phone:314-863-6444
Practice Address - Fax:314-863-6324
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01445103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
27968OtherBLUE CROSS BLUE SHIELD MO
148904OtherHEALTHLINK
015694000OtherMAGELLAN
6115301OtherUNITED HEALTHCARE UNITED
95286OtherEXCLUSIVE CHOICE
000596105OtherAETNA
179630OtherVALUEOPTIONS
680010443OtherRAILROAD MEDICARE
95286OtherEXCLUSIVE CHOICE
680010443OtherRAILROAD MEDICARE
000070994Medicare ID - Type Unspecified