Provider Demographics
NPI:1689769101
Name:GRAMZA, MICHELLE (MA, CCC-SLP, PC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GRAMZA
Suffix:
Gender:F
Credentials:MA, CCC-SLP, PC
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:GRAMZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP, PC
Mailing Address - Street 1:14520 26TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7403
Mailing Address - Country:US
Mailing Address - Phone:206-522-6464
Mailing Address - Fax:
Practice Address - Street 1:14520 26TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7403
Practice Address - Country:US
Practice Address - Phone:206-522-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist