Provider Demographics
NPI:1013626415
Name:GRANT, KERIANNE MARIE
Entity Type:Individual
Prefix:
First Name:KERIANNE
Middle Name:MARIE
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KERRIANNE
Other - Middle Name:MARIE
Other - Last Name:GILHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5615 71ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-8824
Mailing Address - Country:US
Mailing Address - Phone:425-953-3681
Mailing Address - Fax:
Practice Address - Street 1:5615 71ST AVE NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-8824
Practice Address - Country:US
Practice Address - Phone:425-953-3681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician