Provider Demographics
NPI:1104219245
Name:GRIGSBY, KIRBY
Entity Type:Individual
Prefix:
First Name:KIRBY
Middle Name:
Last Name:GRIGSBY
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 1:4848 PIN OAK PARK
Mailing Address - Street 2:APT. 802
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-2272
Mailing Address - Country:US
Mailing Address - Phone:432-770-2112
Mailing Address - Fax:
Practice Address - Street 1:4848 PIN OAK PARK
Practice Address - Street 2:APT. 802
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-2272
Practice Address - Country:US
Practice Address - Phone:432-770-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110375235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist