Healthcare Provider Details

I. General information

NPI: 1003292210
Provider Name (Legal Business Name): ALEXANDREA GRIGG M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1674 S FISHMARKET RD
MCLOUD OK
74851-8300
US

IV. Provider business mailing address

2525 N 187TH CIR
ELKHORN NE
68022-4538
US

V. Phone/Fax

Practice location:
  • Phone: 405-822-6627
  • Fax:
Mailing address:
  • Phone: 405-822-6627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14087640
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: