Healthcare Provider Details

I. General information

NPI: 1588895452
Provider Name (Legal Business Name): AMY MARIE GRISWOLD SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3053 NEW GERMANY RD
EBENSBURG PA
15931-3516
US

IV. Provider business mailing address

598 LUTZVILLE RD
EVERETT PA
15537-6703
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-1100
  • Fax: 814-472-1105
Mailing address:
  • Phone: 724-681-2062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL009198
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: