Provider Demographics
NPI:1699006379
Name:GRAND, LILLIETH I (MS, MT-BC)
Entity Type:Individual
Prefix:MS
First Name:LILLIETH
Middle Name:I
Last Name:GRAND
Suffix:
Gender:F
Credentials:MS, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 SW SWEEK DR APT 1417
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7536
Mailing Address - Country:US
Mailing Address - Phone:503-214-0510
Mailing Address - Fax:
Practice Address - Street 1:8900 SW SWEEK DR APT 1417
Practice Address - Street 2:MILESTONE MUSIC THERAPY
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7536
Practice Address - Country:US
Practice Address - Phone:503-214-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist