Healthcare Provider Details

I. General information

NPI: 1265171904
Provider Name (Legal Business Name): MISS JANINE ANSELMO GRANSTRAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 INLAND DR STE A
NORTH BEND OR
97459-1203
US

IV. Provider business mailing address

14411 15TH AVE SW
BURIEN WA
98166-1034
US

V. Phone/Fax

Practice location:
  • Phone: 541-267-5221
  • Fax:
Mailing address:
  • Phone: 206-384-3969
  • 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: