Provider Demographics
NPI:1982173175
Name:KING GRANT, CARYL DENISE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARYL
Middle Name:DENISE
Last Name:KING GRANT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12713 QUARTERHORSE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4324
Mailing Address - Country:US
Mailing Address - Phone:301-805-4685
Mailing Address - Fax:
Practice Address - Street 1:501 WATKINS PARK DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8801
Practice Address - Country:US
Practice Address - Phone:301-218-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07545235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist