Provider Demographics
NPI:1366008815
Name:MCCLENDON, GRACE BRYSON (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:BRYSON
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 CHAMPIONS CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6866
Mailing Address - Country:US
Mailing Address - Phone:615-604-3105
Mailing Address - Fax:
Practice Address - Street 1:513 CHAMPIONS CT
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6866
Practice Address - Country:US
Practice Address - Phone:615-604-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000005647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist