Provider Demographics
NPI:1053883058
Name:GRANDE, KAREN (CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:GRANDE
Suffix:
Gender:M
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 1:600 RED PUMP RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2112
Mailing Address - Country:US
Mailing Address - Phone:410-638-4252
Mailing Address - Fax:
Practice Address - Street 1:600 RED PUMP RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2112
Practice Address - Country:US
Practice Address - Phone:410-638-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04012235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist