Provider Demographics
NPI:1740577865
Name:GRANSTAFF, LOREN (MA,CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LOREN
Middle Name:
Last Name:GRANSTAFF
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 1:108 CABIN SPGS
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-7224
Mailing Address - Country:US
Mailing Address - Phone:830-460-0680
Mailing Address - Fax:
Practice Address - Street 1:31320 INTERSTATE 10 W STE D
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9238
Practice Address - Country:US
Practice Address - Phone:830-755-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-10
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104952235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist