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Provider Information for 1194976555


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Ms. CODY L GRANDA M.S., LMFT


Sex: Female

NPI: 1194976555
Last Updated: 2015-05-15
Certification Date:

Details

NameValue
NPI1194976555
Enumeration Date2008-10-03
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 5354 PARKDALE DR
SECOND FLOOR
MINNEAPOLIS, MN 55416
United States

Phone: 651-645-5323 | Fax:
 
Primary Practice Address 5354 PARKDALE DR
SECOND FLOOR
MINNEAPOLIS, MN 55416-1603
United States

Phone: 651-645-5323 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 106H00000X - Marriage & Family Therapist MN2455