Provider Demographics
NPI:1972010619
Name:GRANDJEAN, VENESSA (SLPD/CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:VENESSA
Middle Name:
Last Name:GRANDJEAN
Suffix:
Gender:F
Credentials:SLPD/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14610 KELSEY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6824
Mailing Address - Country:US
Mailing Address - Phone:281-460-4412
Mailing Address - Fax:
Practice Address - Street 1:14610 KELSEY VISTA DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6824
Practice Address - Country:US
Practice Address - Phone:281-460-4412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty