Individual
BLAKE GRISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 ELK DR, BURLESON, TX 76028-5957
(817) 835-8373
Mailing address
6705 DAFFODIL CT, FORT WORTH, TX 76137-2346
(817) 727-9147
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
03/18/2025
Last updated
03/18/2025
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