Provider Demographics
NPI:1659630317
Name:GRUNKEMEYER, CAROLYN MENIST (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MENIST
Last Name:GRUNKEMEYER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 GREAT CIRCLE RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1705
Mailing Address - Country:US
Mailing Address - Phone:615-331-1142
Mailing Address - Fax:615-331-1142
Practice Address - Street 1:220 GREAT CIRCLE RD
Practice Address - Street 2:SUITE 124
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1705
Practice Address - Country:US
Practice Address - Phone:615-331-1142
Practice Address - Fax:615-331-1142
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000004689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist