MEDICARE: GRASSYLANE THERAPIES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1235654179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRASSYLANE THERAPIES, LLC

Provider Business Mailing Address
First Line	:	14 GLENWOOD CT
Second Line	:
City	:	BETHANY
State	:	CT
Zip	:	06524-3319
Country	:	US
Telephone Number	:	203-314-1991
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 GLENWOOD CT
Second Line	:
City	:	BETHANY
State	:	CT
Zip	:	06524-3319
Country	:	US
Telephone Number	:	203-314-1991
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MRS. JOAN L BLACK
Credential	:	MS, CCC/SLP
Telephone Number	:	203-314-1991

Provider Enumeration Date	:	08/11/2017
Last Update Date	:	07/21/2022

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