Provider Demographics
NPI:1659097814
Name:GRIFFITH, MONIKA L
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:L
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 RIDGEDALE ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77803-3722
Mailing Address - Country:US
Mailing Address - Phone:979-209-2770
Mailing Address - Fax:979-209-2789
Practice Address - Street 1:1201 RIDGEDALE ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-3722
Practice Address - Country:US
Practice Address - Phone:979-209-2770
Practice Address - Fax:979-209-2789
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist