Provider Demographics
NPI:1508232307
Name:GRAMS, KATLYN ANN
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:ANN
Last Name:GRAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 N COUNTRY CLUB DR
Mailing Address - Street 2:APT 3066
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-2546
Mailing Address - Country:US
Mailing Address - Phone:661-414-6074
Mailing Address - Fax:
Practice Address - Street 1:4101 E BASELINE RD
Practice Address - Street 2:#1512
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-9101
Practice Address - Country:US
Practice Address - Phone:480-818-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-15
Last Update Date:2015-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ96012355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant