Individual
EVELYN BERGH GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. CCC/SLP
Contact information
Practice address
10000 W 75TH ST, SUITE 250, MERRIAM, KS 66204-2209
(913) 894-1910
Mailing address
4108 W 129TH ST, LEAWOOD, KS 66209-3308
(913) 814-8066
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
01559
MO
235Z00000X
Speech-Language Pathologist
Primary
336
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01559
STATE LICENSE
MO
01
—
336
STATE LICENSE
KS
Enumeration date
10/21/2008
Last updated
10/21/2008
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