Provider Demographics
NPI:1740493170
Name:GRENDA, NANCY HALE (SLP)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:HALE
Last Name:GRENDA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 SHINE CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8756
Mailing Address - Country:US
Mailing Address - Phone:317-571-1410
Mailing Address - Fax:317-571-1410
Practice Address - Street 1:4222 SHINE CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-8756
Practice Address - Country:US
Practice Address - Phone:317-571-1410
Practice Address - Fax:317-571-1410
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002065235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist