Provider Demographics
NPI:1962645721
Name:GRINAGE, DIANE MARIE (MA, MS - CCC/SLP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:GRINAGE
Suffix:
Gender:F
Credentials:MA, MS - CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8622 BLACKPOOL DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4315
Mailing Address - Country:US
Mailing Address - Phone:703-764-8222
Mailing Address - Fax:
Practice Address - Street 1:3750 OLD LEE HIGHWAY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-246-7194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist