Doctor Name: | MRS. GINA GRANDE |
NPI Number: | 1962773341 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. |
License Number: | 016656 |
Business Practice Address: | 320 Fletcher Ave Valley Stream, NY - 115803309 |
Business Phone Number: | 6318727748 |
Business Fax Number: | |
Mailing Address: | 19 Elmwood Rd, DEER PARK |
State: | NY |
Postal Code: | 117296105 |
Phone Number: | 6317960038 |
Fax Number: | |
NPI Enumeration Date: | 01/18/2012 |
NPI Last Update Date: | 01/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 016656 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
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 |