Provider Demographics
NPI:1083079818
Name:GRAWUNDER, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GRAWUNDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S COULTER ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2721
Mailing Address - Country:US
Mailing Address - Phone:806-355-7942
Mailing Address - Fax:
Practice Address - Street 1:3300 S COULTER ST
Practice Address - Street 2:SUITE 4
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2721
Practice Address - Country:US
Practice Address - Phone:806-355-7942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80696237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist