Provider Demographics
NPI:1477071496
Name:GREJDA, KEVIN PATRICK
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:PATRICK
Last Name:GREJDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3695
Mailing Address - Country:US
Mailing Address - Phone:847-328-5700
Mailing Address - Fax:
Practice Address - Street 1:1400 GRIFFIN MILL RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-6929
Practice Address - Country:US
Practice Address - Phone:864-397-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5934235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist