Provider Demographics
NPI:1730104126
Name:GRANT, GAIL (AUD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31112 SIERRA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-4590
Mailing Address - Country:US
Mailing Address - Phone:210-439-9144
Mailing Address - Fax:
Practice Address - Street 1:31112 SIERRA VISTA DR STE B
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-4590
Practice Address - Country:US
Practice Address - Phone:210-439-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80204231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist