Provider Demographics
NPI:1942553524
Name:GRADY, PATRICIA LYNNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNNE
Last Name:GRADY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 RIVER AVE UNIT 40152
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-0803
Mailing Address - Country:US
Mailing Address - Phone:541-913-9313
Mailing Address - Fax:
Practice Address - Street 1:1639 OAK ST STE D
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4088
Practice Address - Country:US
Practice Address - Phone:541-913-9313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60308709235Z00000X
ID235Z00000X
OR13247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist