Provider Demographics
NPI:1760922561
Name:GREWELL, CONOR
Entity Type:Individual
Prefix:
First Name:CONOR
Middle Name:
Last Name:GREWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3592 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1018
Mailing Address - Country:US
Mailing Address - Phone:740-452-7121
Mailing Address - Fax:740-452-3940
Practice Address - Street 1:3592 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1018
Practice Address - Country:US
Practice Address - Phone:740-452-7121
Practice Address - Fax:740-452-3940
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03327237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist