MEDICARE: EARLY FOUNDATIONS SPEECH AND FEEDING SERVICES

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	:	1942942651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARLY FOUNDATIONS SPEECH AND FEEDING SERVICES

Provider Business Mailing 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	:

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	:	OWNER
Name	:	COURTNEY GRYSEN
Credential	:
Telephone Number	:	616-217-7810

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

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Directions to “EARLY FOUNDATIONS SPEECH AND FEEDING SERVICES ” Practice Location

Language	Start Address	Practice Location

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