Provider Demographics
NPI:1336362003
Name:GRANUM, LANI (MA, LCSW)
Entity Type:Individual
Prefix:
First Name:LANI
Middle Name:
Last Name:GRANUM
Suffix:
Gender:F
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5433 S EAST VIEW PARK
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5915
Mailing Address - Country:US
Mailing Address - Phone:773-752-6590
Mailing Address - Fax:
Practice Address - Street 1:233 E WACKER DR
Practice Address - Street 2:#4307
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5104
Practice Address - Country:US
Practice Address - Phone:312-946-8413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1490003571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical