MEDICARE: WENDY GRANT M.A.

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	235Z00000X	Speech-Language Pathologist	SA1282	FL
2	237600000X	Audiologist-Hearing Aid Fitter

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S0886	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639131097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY GRANT M.A.

Provider Business Mailing Address
First Line	:	3540 FOREST HILL BLVD
Second Line	:	STE 205
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5878
Country	:	US
Telephone Number	:	561-649-4006
Fax Number	:	561-969-6621

Provider Business Practice Location Address
First Line	:	3540 FOREST HILL BLVD
Second Line	:	SUITE 205
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5878
Country	:	US
Telephone Number	:	561-649-4006
Fax Number	:	561-969-6621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	12/05/2014

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Directions to “ WENDY GRANT M.A.” Practice Location

Language	Start Address	Practice Location

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