Provider Demographics
NPI:1639280464
Name:GRANDEY, KATHRINE (MSSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRINE
Middle Name:
Last Name:GRANDEY
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12871 N HIGHWAY 183
Mailing Address - Street 2:201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-3248
Mailing Address - Country:US
Mailing Address - Phone:512-250-9735
Mailing Address - Fax:512-250-2110
Practice Address - Street 1:12871 N HIGHWAY 183
Practice Address - Street 2:201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-3248
Practice Address - Country:US
Practice Address - Phone:512-250-9735
Practice Address - Fax:512-250-2110
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0033151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S66DMedicare ID - Type Unspecified