Provider Demographics
NPI:1811626914
Name:GRANT, ANNIE EMERY
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:EMERY
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5519 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5841
Mailing Address - Country:US
Mailing Address - Phone:602-292-3388
Mailing Address - Fax:
Practice Address - Street 1:4600 GREENVILLE AVE STE 160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5036
Practice Address - Country:US
Practice Address - Phone:214-736-2230
Practice Address - Fax:214-736-2229
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42485235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist