Provider Demographics
NPI:1174021224
Name:GRASSO, BRIANNA N (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:N
Last Name:GRASSO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 S BRANCH RD STE 405
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-8211
Mailing Address - Country:US
Mailing Address - Phone:908-369-3669
Mailing Address - Fax:
Practice Address - Street 1:378 S BRANCH RD STE 405
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-8211
Practice Address - Country:US
Practice Address - Phone:908-369-3669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00766500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist