Provider Demographics
NPI:1467197996
Name:GRISSOM, MEREDITH (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:GRISSOM
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3553 SHINER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-2189
Mailing Address - Country:US
Mailing Address - Phone:601-259-8687
Mailing Address - Fax:
Practice Address - Street 1:463155 STATE ROAD 200 STE 12
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-5506
Practice Address - Country:US
Practice Address - Phone:904-849-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10205235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist