Basic Information
| Provider Information | |||||||||
| NPI: | 1740454024 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAINGER | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MS CCC SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 MAHALANI ST | ||||||||
| Address2: | STE 19A | ||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082447467 | ||||||||
| FaxNumber: | 8082424762 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 MAHALANI ST | ||||||||
| Address2: | STE 19A | ||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082447467 | ||||||||
| FaxNumber: | 8082424762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2008 | ||||||||
| LastUpdateDate: | 04/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SPA769 | HI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.