Provider Demographics
NPI:1326546011
Name:GRUNDEN, HEATHER FARISS (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:FARISS
Last Name:GRUNDEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4322
Mailing Address - Country:US
Mailing Address - Phone:434-245-2416
Mailing Address - Fax:434-245-2616
Practice Address - Street 1:508 HARRIS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4322
Practice Address - Country:US
Practice Address - Phone:434-245-2416
Practice Address - Fax:434-245-2616
Is Sole Proprietor?:No
Enumeration Date:2018-01-27
Last Update Date:2018-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003820235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist