Basic Information
| Provider Information | |||||||||
| NPI: | 1154045664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRILLO | ||||||||
| FirstName: | MADDISON | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | SLT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 402 AUBURN DR | ||||||||
| Address2: | |||||||||
| City: | CRANBERRY TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160664842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125193625 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3950 WILLIAM PENN HWY | ||||||||
| Address2: | |||||||||
| City: | MURRYSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156681870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124877771 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2022 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL016562 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.