Provider Demographics
NPI:1821083775
Name:GRANT, PATRICIA JUDE (MA, CCC, COM)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JUDE
Last Name:GRANT
Suffix:
Gender:F
Credentials:MA, CCC, COM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 TRAFFIC WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3368
Mailing Address - Country:US
Mailing Address - Phone:805-441-1055
Mailing Address - Fax:805-904-6133
Practice Address - Street 1:210 TRAFFIC WAY
Practice Address - Street 2:SUITE C
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3368
Practice Address - Country:US
Practice Address - Phone:805-441-1055
Practice Address - Fax:805-904-6133
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP-6072235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist