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General NPI Number Information
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NPI Number | 1639310972
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Entity Type | Individual
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Provider Name | DIANA CAROL GRANGER M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 65 CORDAGE PARK CIR
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City | PLYMOUTH
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State | MA
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Zip | 02360-7322
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Country | US
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Telephone | 508-747-4720
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Fax |
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Provider Business Mailing Address
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Address Line | 291 FALMOUTH WOODS RD
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City | EAST FALMOUTH
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State | MA
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Zip | 02536-7919
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Country | US
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Telephone | 508-540-5846
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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 | 2762
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License Number State | MA
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