Provider Demographics
NPI:1043963101
Name:GRANDAL, LAUREN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GRANDAL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ROGER NORTON PL
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3346
Mailing Address - Country:US
Mailing Address - Phone:908-721-1815
Mailing Address - Fax:
Practice Address - Street 1:281 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4279
Practice Address - Country:US
Practice Address - Phone:908-358-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00929600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist