Provider Demographics
NPI:1871021196
Name:GRADOWSKI, RANAE MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RANAE
Middle Name:MARIE
Last Name:GRADOWSKI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SOUTHLAWN DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MI
Mailing Address - Zip Code:48611-9449
Mailing Address - Country:US
Mailing Address - Phone:989-513-3703
Mailing Address - Fax:
Practice Address - Street 1:304 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-7264
Practice Address - Country:US
Practice Address - Phone:989-832-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist