Provider Demographics
NPI:1679975684
Name:GRANT-RAUCCI, LISA VALE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:VALE
Last Name:GRANT-RAUCCI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-4528
Mailing Address - Country:US
Mailing Address - Phone:937-278-5885
Mailing Address - Fax:
Practice Address - Street 1:2011 TIMBER LN
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-4528
Practice Address - Country:US
Practice Address - Phone:937-278-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP6788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist