1780018473 NPI number — MRS. MIKAL MELANIE GRAINGER CFY, SLP

Table of content: MRS. MIKAL MELANIE GRAINGER CFY, SLP (NPI 1780018473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780018473 NPI number — MRS. MIKAL MELANIE GRAINGER CFY, SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAINGER
Provider First Name:
MIKAL
Provider Middle Name:
MELANIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CFY, SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LADD (MAIDEN)
Provider Other First Name:
MIKI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1780018473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 17TH AVE SO.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-771-4500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 17TH AVE SO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREAT FALLS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-771-4500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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