Provider Demographics
NPI:1831137371
Name:GRIZZLE, MAISIE S (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAISIE
Middle Name:S
Last Name:GRIZZLE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MAISIE
Other - Middle Name:C
Other - Last Name:SHRIEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:23379 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:ACCOMAC
Mailing Address - State:VA
Mailing Address - Zip Code:23301-1314
Mailing Address - Country:US
Mailing Address - Phone:757-787-8284
Mailing Address - Fax:757-787-4931
Practice Address - Street 1:23379 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:ACCOMAC
Practice Address - State:VA
Practice Address - Zip Code:23301-1314
Practice Address - Country:US
Practice Address - Phone:757-787-8284
Practice Address - Fax:757-787-4931
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist