Provider Demographics
NPI:1326299074
Name:GRIEP, BRITTANY B
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:B
Last Name:GRIEP
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:PO BOX 1306
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-1306
Mailing Address - Country:US
Mailing Address - Phone:318-255-9601
Mailing Address - Fax:318-255-7971
Practice Address - Street 1:1923 FARMERVILLE HWY
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3007
Practice Address - Country:US
Practice Address - Phone:318-255-9601
Practice Address - Fax:318-255-7971
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4591235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG5096OtherBCBS OF LOUISIANA
LA1169234Medicaid
LA1169234Medicaid