Provider Demographics
NPI:1740605898
Name:GRENIER, ELLEN (MED)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:GRENIER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:GRENIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED
Mailing Address - Street 1:32 NORWAY ST
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-3143
Mailing Address - Country:US
Mailing Address - Phone:413-567-0374
Mailing Address - Fax:
Practice Address - Street 1:32 NORWAY ST
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-3143
Practice Address - Country:US
Practice Address - Phone:413-567-0374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA042-430-193235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist