Provider Demographics
NPI:1346563947
Name:GRINER, ASHLEY HOLT (SPEECH & AUDIOLOGY)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:HOLT
Last Name:GRINER
Suffix:
Gender:F
Credentials:SPEECH & AUDIOLOGY
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:SUZANNE
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:3809 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-6645
Mailing Address - Country:US
Mailing Address - Phone:229-400-1142
Mailing Address - Fax:
Practice Address - Street 1:99 E BROAD ST
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-1807
Practice Address - Country:US
Practice Address - Phone:229-336-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET001492235Z00000X
GASLP007412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist