Provider Demographics
NPI:1760689822
Name:NADEAU-GRANDY, KEARA PATRICE (LICSW)
Entity type:Individual
Prefix:MS
First Name:KEARA
Middle Name:PATRICE
Last Name:NADEAU-GRANDY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7880 EASTWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:MOUNDS VIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55112-4311
Mailing Address - Country:US
Mailing Address - Phone:612-272-4589
Mailing Address - Fax:
Practice Address - Street 1:245 S. CLIFTON AVENUE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403
Practice Address - Country:US
Practice Address - Phone:612-870-3787
Practice Address - Fax:612-870-3789
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical