Provider Demographics
NPI:1679854988
Name:MCGRAIN, DEBRA A (PROGRAM DIRECTOR)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:MCGRAIN
Suffix:
Gender:F
Credentials:PROGRAM DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 39TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7015
Mailing Address - Country:US
Mailing Address - Phone:262-654-1004
Mailing Address - Fax:262-654-6960
Practice Address - Street 1:6233 39TH AVENUE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7015
Practice Address - Country:US
Practice Address - Phone:262-654-1004
Practice Address - Fax:262-654-6960
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator