Provider Demographics
NPI:1497491831
Name:GRANT-KEIL, JOSEPH SAMUEL
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SAMUEL
Last Name:GRANT-KEIL
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 1:31112 SIERRA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-4590
Mailing Address - Country:US
Mailing Address - Phone:210-382-8702
Mailing Address - Fax:
Practice Address - Street 1:4265 45TH ST S STE 137
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4326
Practice Address - Country:US
Practice Address - Phone:701-929-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDH-0404237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist