Provider Demographics
NPI:1053142299
Name:GRANT, JULIE DIANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:DIANNE
Last Name:GRANT
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 1:3462 FM 1997 N
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-2508
Mailing Address - Country:US
Mailing Address - Phone:903-513-1274
Mailing Address - Fax:
Practice Address - Street 1:815 BIRCH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2322
Practice Address - Country:US
Practice Address - Phone:903-295-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121592235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist