Provider Demographics
NPI:1578707576
Name:GRUNWALD, JUDITH E (SLP)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:E
Last Name:GRUNWALD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PRESIDENT ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4481
Mailing Address - Country:US
Mailing Address - Phone:443-604-2487
Mailing Address - Fax:443-853-3765
Practice Address - Street 1:1 E CHASE ST STE 1108
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2564
Practice Address - Country:US
Practice Address - Phone:443-604-2487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00855235Z00000X
NY013634-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00855OtherSPEECH-LANGUAGE PATHOLOGY LICENSE