Individual
GRANT OLLENBURGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4033 BURBANK DR APT 6, BATON ROUGE, LA 70808-4416
(708) 415-7278
Mailing address
4033 BURBANK DR APT 6, BATON ROUGE, LA 70808-4416
(708) 415-7278
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
LA
Other
Enumeration date
06/03/2014
Last updated
06/03/2014
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