Basic Information
Provider Information
NPI: 1336408277
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HILL
FirstName: GRAYSON
MiddleName: BRUNSON
NamePrefix: MRS.
NameSuffix:  
Credential: MS, CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 40277
Address2:  
City: MOBILE
State: AL
PostalCode: 366400277
CountryCode: US
TelephoneNumber: 2514459378
FaxNumber: 2514459377
Practice Location
Address1: USA ALLIED HEALTH PROFESSIONS
Address2: 5721 USA NORTH DRIVE, HAHN 1119
City: MOBILE
State: AL
PostalCode: 366880002
CountryCode: US
TelephoneNumber: 2514459378
FaxNumber: 2514459377
Other Information
ProviderEnumerationDate: 05/13/2012
LastUpdateDate: 08/29/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X1569ALY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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