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General NPI Number Information
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NPI Number | 1427404342
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Entity Type | Organization
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Legal Business Name | GRANDLAN SPEECH THERAPY LLC
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 11607 LITTLE BAY HARBOR WAY
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City | SPOTSYLVANIA
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State | VA
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Zip | 22551-8905
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Country | US
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Telephone | 914-589-9815
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Fax | 540-693-7025
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Provider Business Mailing Address
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Address Line | 11607 LITTLE BAY HARBOR WAY
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City | SPOTSYLVANIA
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State | VA
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Zip | 22551-8905
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Country | US
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Telephone | 914-589-9815
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Fax | 540-693-7025
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST OWNER
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Name | VANESSA GRANDE
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Credential | MS SLP
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Telephone | 914-589-9815
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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 | 2202006582
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License Number State | VA
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