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General NPI Number Information
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NPI Number | 1992088033
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Entity Type | Individual
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Provider Name | JOHNWANETTA MESHAE GRAYSON-RODGERS M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/26/2011
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Last Update Date | 09/26/2011
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Provider Practice Location Address
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Address Line | 4211 GARDENDALE ST STE 200A
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3143
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Country | US
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Telephone | 210-615-7837
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Fax |
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Provider Business Mailing Address
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Address Line | 10703 COYOTE HL
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City | CONVERSE
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State | TX
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Zip | 78109-2415
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Country | US
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Telephone | 210-854-7073
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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 | 12106351
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License Number State | TX
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