MEDICARE: COURTNEY GRYSEN

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

General Provider Information

NPI Number	:	1710548813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY GRYSEN

Provider Business Mailing Address
First Line	:	6595 PORT SHELDON ST
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-9514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6595 PORT SHELDON ST
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-9514
Country	:	US
Telephone Number	:	616-217-7810
Fax Number	:

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

Provider Enumeration Date	:	06/28/2019
Last Update Date	:	04/12/2022

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Directions to “ COURTNEY GRYSEN ” Practice Location

Language	Start Address	Practice Location

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