Provider Demographics
NPI:1083744387
Name:GRINSTEAD, MARGARET JENNIFER (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:JENNIFER
Last Name:GRINSTEAD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 DENNIS WAY
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3072
Mailing Address - Country:US
Mailing Address - Phone:505-887-8027
Mailing Address - Fax:
Practice Address - Street 1:805 DENNIS WAY
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3072
Practice Address - Country:US
Practice Address - Phone:505-887-8027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP2428Medicaid