Healthcare Provider Details

I. General information

NPI: 1013289545
Provider Name (Legal Business Name): JANICE L GRENFELL SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15802 N. PARKVIEW PL
SURPRISE AZ
85374
US

IV. Provider business mailing address

18127 N FIESTA DR. .
SURPRISE AZ
85374
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7000
  • Fax:
Mailing address:
  • Phone: 208-691-7477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number#SLPA7524
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: