Provider Demographics
NPI:1104188630
Name:GRANT, BRANDI
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:LECAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 N BROOM ST FLOOR 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703
Mailing Address - Country:US
Mailing Address - Phone:608-301-5708
Mailing Address - Fax:608-729-3434
Practice Address - Street 1:301 N BROOM ST FLOOR 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703
Practice Address - Country:US
Practice Address - Phone:608-301-5708
Practice Address - Fax:608-729-3434
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical