Grady, Mark W
Grady, Mark W is an individual health care provider with primary practice located at 240 Maple Street , Woodruff WI 54568-0470. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Grady, Mark W can be contacted via phone (715) 356-8000.Contact Information
Primary practice address
240 Maple Street
Woodruff WI 54568-0470
Phone: (715) 356-8000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 14200 | Wisconsin |
Profile Details
| NPI number | 1154411528 |
|---|---|
| LBN Legal business name | Grady, Mark W |
| Credentials | CADCIII |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 13th, 2006 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1154411528 | NPPES |
| Wisconsin | MEDICAID | 39333500 |
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