Individual
AMANDA GRISSOM V
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
206 MARYLAND AVE, MCCOMB, MS 39648-3926
(601) 250-4815
(601) 250-4815
Mailing address
5321 CAMBRIDGE DR, NORTHPORT, AL 35473-1085
(601) 250-4815
(601) 250-6859
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S2832
MS
Other
Enumeration date
05/17/2007
Last updated
07/08/2007
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