Shelly Grant, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

19593 Issued in MN

Practice address

715 Florida Ave S Ste 307
St Louis Park, MN 55426-1759

Phone

(952) 544-6808

Fax

(952) 545-0098

NPI assigned

Jun 18, 2014

Last updated

Jun 18, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403049600000",
    "number": "1073927968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17858 COBBLESTONE WAY",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553472140",
            "telephone_number": "612-327-8326",
            "fax_number": "952-545-0098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 FLORIDA AVE S STE 307",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261759",
            "telephone_number": "952-544-6808",
            "fax_number": "952-545-0098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "SHELLY",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-18",
        "last_updated": "2014-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "19593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grand St Paul CVS LLC (CVS Pharmacy #17269)
• Grand St Paul CVS LLC (CVS Pharmacy # 06649)
• Grand St Paul CVS LLC (CVS Pharmacy #16078)
• James Grant
• Lucreshia Grant, MS
• Steven Christopher Gravatt
• Kera L T Graves, OTR/L
• Jill Maven Gray, PSYD, LP
• Mary Helen Gray, R.N., N.P
• Paul W Gray, CRNA

• Clinical Social Worker in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.