Provider Demographics
NPI:1841560711
Name:GRANT, JANE ELAINE (MS, LBSW)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ELAINE
Last Name:GRANT
Suffix:
Gender:F
Credentials:MS, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17341 STRASBURG ST
Mailing Address - Street 2:SAME
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-3147
Mailing Address - Country:US
Mailing Address - Phone:313-372-4279
Mailing Address - Fax:
Practice Address - Street 1:17341 STRASBURG ST
Practice Address - Street 2:SAME
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-3147
Practice Address - Country:US
Practice Address - Phone:313-372-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802063653104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker