Provider Demographics
NPI:1720110646
Name:GRANGER, LYNNETTE L (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LYNNETTE
Middle Name:L
Last Name:GRANGER
Suffix:
Gender:F
Credentials: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 1:840 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-2767
Mailing Address - Country:US
Mailing Address - Phone:954-565-4437
Mailing Address - Fax:954-565-4476
Practice Address - Street 1:840 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-2767
Practice Address - Country:US
Practice Address - Phone:954-565-4437
Practice Address - Fax:954-565-4476
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist