Individual
SUSAN GRISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6776 LAKE DRIVE, ADVANCE THERAPY, LINO LAKES, MN 55014
(651) 498-2071
Mailing address
13585 ELKWOOD DR, APPLE VALLEY, MN 55124-5232
(952) 451-4575
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
251272
MN
Other
Enumeration date
12/06/2013
Last updated
12/06/2013
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