MEDICARE: MRS. DONNA JEAN GRANT

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	006346	NY

General Provider Information

NPI Number	:	1851438618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA JEAN GRANT

Provider Business Mailing Address
First Line	:	3959 N BUFFALO ST
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-1841
Country	:	US
Telephone Number	:	716-667-7459
Fax Number	:	716-667-2395

Provider Business Practice Location Address
First Line	:	3959 N BUFFALO ST
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-1841
Country	:	US
Telephone Number	:	716-667-7459
Fax Number	:	716-667-2395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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