Organization
CENTRAL COAST SPEECH PATHOLOGY AND OROFACIAL MYOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA J GRANT MA (OWNER/OPERATOR)
(805) 441-1055
Entity
Organization
Contact information
Practice address
210 TRAFFIC WAY, SUITE C, ARROYO GRANDE, CA 93420-3368
(805) 441-1055
(805) 904-6133
Mailing address
210 TRAFFIC WAY, SUITE C, ARROYO GRANDE, CA 93420-3368
(805) 441-1055
(805) 904-6133
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
Primary
S96072
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1821083775
NPI
CA
Enumeration date
07/14/2016
Last updated
07/14/2016
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