Provider Demographics
NPI:1083124283
Name:GRANDIERI, BERNADETTE M (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:M
Last Name:GRANDIERI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:921 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-9744
Mailing Address - Country:US
Mailing Address - Phone:724-471-2942
Mailing Address - Fax:721-801-8147
Practice Address - Street 1:501 PLUSH MILL RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-6040
Practice Address - Country:US
Practice Address - Phone:724-471-2942
Practice Address - Fax:724-801-8147
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013601235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist