Provider Demographics
NPI:1598437535
Name:GRANGER, SHARON BELL (MCD,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:BELL
Last Name:GRANGER
Suffix:
Gender:F
Credentials:MCD,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 PEAVY RD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-9514
Mailing Address - Country:US
Mailing Address - Phone:337-208-4615
Mailing Address - Fax:
Practice Address - Street 1:720 RUSK ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:TX
Practice Address - Zip Code:75966-3236
Practice Address - Country:US
Practice Address - Phone:337-208-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2980235Z00000X
TX18953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist