Mark W Grady, CADCIII
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Woodruff, WI
NPI 1154411528 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1154411528
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 14200 (WI)
- Practice address
- 240 Maple Street
Woodruff, WI 54568-0470 - Phone
- (715) 356-8000
- NPI assigned
- Oct 13, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14200 | WI | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 14200 | WI | Yes |
Addresses
Primary practice location
240 Maple Street
Woodruff, WI 54568-0470
Mailing address
240 Maple Street
PO Box 470
Woodruff, WI 54568-0470
Phone (715) 356-8000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39333500 | Medicaid | WI |
Other providers in Woodruff, WI
- Kyle Micheal Gamoke
- Michel P Gelinas
- Gonzalez Family Chiropractic LLC.
- Guillermo Eduardo Gonzalez
- Roger John Gorectke
- Whitney Lynn Graham
- Lonna L Grosskopf
- Ronald S Hagen
- James A. Halminiak
- Kelly E Hamerla
All providers in Woodruff, WI · Addiction (Substance Use Disorder) Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.