Provider Demographics
NPI:1083737621
Name:GRANDITS, HEATHER D
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:GRANDITS
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 1:1006 MASTER GUNNER CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-3432
Mailing Address - Country:US
Mailing Address - Phone:704-619-6600
Mailing Address - Fax:704-234-2577
Practice Address - Street 1:1006 MASTER GUNNER CT
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-3432
Practice Address - Country:US
Practice Address - Phone:704-619-6600
Practice Address - Fax:704-234-2577
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist