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General NPI Number Information
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NPI Number | 1336043967
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Entity Type | Individual
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Provider Name | ANGELA EASTMAN GRISSOM MS, SLP-CCC
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Gender | Female
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 441 N WERTH BLVD
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City | NEWBERG
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State | OR
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Zip | 97132-7500
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Country | US
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Telephone | 503-538-9436
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Fax |
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Provider Business Mailing Address
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Address Line | 19501 NE HERRING LN
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City | NEWBERG
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State | OR
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Zip | 97132-7450
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Country | US
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Telephone | 510-731-8010
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 12136518
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License Number State | OR
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