| NPI | 1053087296 |
|---|---|
| Former Name | KELLY GRYNIEWICZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851115845) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801120421) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2025-10-14 |