| Organization Name: | EASTSIDE SPEECH AND PATHOLOGY |
| NPI Number: | 1598891483 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LYNNETTE L GRANGER (PRESIDENT) |
| Mailing Address: | 840 E Oakland Park Blvd Suite 115 Oakland Park |
| State: | FL US |
| Postal Code: | 333342767 |
| Phone Number: | 9545654437 |
| Fax Number: | 9545654476 |
| NPI Enumeration Date: | 02/26/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2007001985 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |