Individual
TARA GRISSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
1011 N CAUSEWAY BLVD STE 25, MANDEVILLE, LA 70471-3282
(985) 626-8403
Mailing address
568 PELICAN RIDGE DR, MADISONVILLE, LA 70447-9248
(985) 264-6856
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4782
LA
Other
Enumeration date
08/10/2021
Last updated
08/10/2021
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