Provider Demographics
NPI:1922348408
Name:GRALL, LAWRENCE HOWARD
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:HOWARD
Last Name:GRALL
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 1:107 DRY CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-9106
Mailing Address - Country:US
Mailing Address - Phone:806-676-3589
Mailing Address - Fax:
Practice Address - Street 1:107 DRY CREEK TRL
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729-9106
Practice Address - Country:US
Practice Address - Phone:806-676-3589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist