Provider Demographics
NPI:1588007199
Name:GRONDIN, BRIANNA K (SLPA)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:K
Last Name:GRONDIN
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 LAREE AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:86324-3238
Mailing Address - Country:US
Mailing Address - Phone:928-821-4649
Mailing Address - Fax:
Practice Address - Street 1:101 S AIRPARK RD
Practice Address - Street 2:SUITE M
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4182
Practice Address - Country:US
Practice Address - Phone:928-639-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA82562355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant