Provider Demographics
NPI:1669907838
Name:GRANTHAM, TAYLOR (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:
Last Name:GRANTHAM
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:MRS
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:GRANTHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:207 MUSGROVE ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-5321
Mailing Address - Country:US
Mailing Address - Phone:325-235-7799
Mailing Address - Fax:
Practice Address - Street 1:207 MUSGROVE ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-5321
Practice Address - Country:US
Practice Address - Phone:325-235-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist