| Doctor Name: | AMANDA GRISSOM |
| NPI Number: | 1639386444 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | S2832 |
| Business Practice Address: | 206 Maryland Ave Mccomb, MS - 396483926 |
| Business Phone Number: | 6012504815 |
| Business Fax Number: | 6012504815 |
| Mailing Address: | 5321 Cambridge Dr, NORTHPORT |
| State: | AL |
| Postal Code: | 354731085 |
| Phone Number: | 6012504815 |
| Fax Number: | 6012506859 |
| NPI Enumeration Date: | 05/17/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | S2832 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| 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 |