Individual
MRS. NIKKI MARY GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.SLP
Contact information
Practice address
10560 OLD OLIVE STREET RD, SUITE100, CREVE COEUR, MO 63141-5916
(314) 567-4707
(314) 567-4505
Mailing address
1870 BUCKINGTON DR, CHESTERFIELD, MO 63017-8040
(636) 394-4590
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
00078
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114090792
GROUP NPI
MO
Enumeration date
01/27/2007
Last updated
07/09/2007
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