Healthcare Provider Details

I. General information

NPI: 1710548813
Provider Name (Legal Business Name): COURTNEY GRYSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6595 PORT SHELDON ST
HUDSONVILLE MI
49426-9514
US

IV. Provider business mailing address

6595 PORT SHELDON ST
HUDSONVILLE MI
49426-9514
US

V. Phone/Fax

Practice location:
  • Phone: 616-217-7810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: