MEDICARE: GRANDLAN SPEECH THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2202006582	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427404342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANDLAN SPEECH THERAPY LLC

Provider Business Mailing Address
First Line	:	11607 LITTLE BAY HARBOR WAY
Second Line	:
City	:	SPOTSYLVANIA
State	:	VA
Zip	:	22551-8905
Country	:	US
Telephone Number	:	914-589-9815
Fax Number	:	540-693-7025

Provider Business Practice Location Address
First Line	:	11607 LITTLE BAY HARBOR WAY
Second Line	:
City	:	SPOTSYLVANIA
State	:	VA
Zip	:	22551-8905
Country	:	US
Telephone Number	:	914-589-9815
Fax Number	:	540-693-7025

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST OWNER
Name	:	VANESSA GRANDE
Credential	:	MS SLP
Telephone Number	:	914-589-9815

Provider Enumeration Date	:	05/10/2016
Last Update Date	:	05/10/2016

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Directions to “GRANDLAN SPEECH THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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