Provider Information for 1184955700
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TARRAH A GRADY LCSW
Other Names:Former Name:TARRAH HICKERSON LCSWSex: Female
NPI: 1184955700
Last Updated: 2024-08-27
Certification Date: 2024-08-27
Certification Date: 2024-08-27
Details
Name | Value | ||||||||||||||
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NPI | 1184955700 | ||||||||||||||
Enumeration Date | 2010-01-21 | ||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||
Sole Proprietor | NO | ||||||||||||||
Status | Active | ||||||||||||||
Mailing Address | 2305 GEORGIA ST LOUISIANA, MO 63353-2559 United States Phone: 573-754-4584 | Fax: | ||||||||||||||
Primary Practice Address | 2305 GEORGIA ST LOUISIANA, MO 63353-2559 United States Phone: 573-754-4584 | Fax: | ||||||||||||||
Secondary Practice Address(es) | 1032 CROSSWINDS CT | ||||||||||||||
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