Provider Demographics
NPI:1700632395
Name:GRANGER, SOPHIE (GC)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:GRANGER
Suffix:
Gender:F
Credentials:GC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 NW 77TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-4665
Mailing Address - Country:US
Mailing Address - Phone:816-898-0326
Mailing Address - Fax:
Practice Address - Street 1:8310 NW 77TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64152-4665
Practice Address - Country:US
Practice Address - Phone:816-898-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170300000XOther Service ProvidersGenetic Counselor, MSGroup - Multi-Specialty