Provider Demographics
NPI:1639605694
Name:GRADE, JOSHUA RANDALL (LCSW)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RANDALL
Last Name:GRADE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 W VERBENA DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1238
Mailing Address - Country:US
Mailing Address - Phone:208-559-6197
Mailing Address - Fax:
Practice Address - Street 1:1322 W VERBENA DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1238
Practice Address - Country:US
Practice Address - Phone:208-559-6197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-408921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical