Provider Demographics
NPI:1245722123
Name:GRASSROOTS THERAPY SOLUTIONS, PLLC
Entity type:Organization
Organization Name:GRASSROOTS THERAPY SOLUTIONS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:ZOE
Authorized Official - Last Name:KRAAYEVELD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:360-903-0573
Mailing Address - Street 1:618 N 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-7839
Mailing Address - Country:US
Mailing Address - Phone:360-903-0573
Mailing Address - Fax:360-326-2202
Practice Address - Street 1:618 N 44TH AVE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-7839
Practice Address - Country:US
Practice Address - Phone:360-903-0573
Practice Address - Fax:360-326-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60158862261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech