Healthcare Provider Details

I. General information

NPI: 1720856909
Provider Name (Legal Business Name): SAMANTHA ERIN GRIGG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 IRON GATE RD
BEL AIR MD
21014-3358
US

IV. Provider business mailing address

516 IRON GATE RD
BEL AIR MD
21014-3358
US

V. Phone/Fax

Practice location:
  • Phone: 443-717-4216
  • Fax:
Mailing address:
  • Phone: 443-717-4216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11033
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: