Provider Demographics
NPI:1902905599
Name:GRIDER, ROBERT BRADY (MS/CCC-SP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRADY
Last Name:GRIDER
Suffix:
Gender:M
Credentials:MS/CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4219
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-0494
Mailing Address - Country:US
Mailing Address - Phone:952-929-1981
Mailing Address - Fax:952-206-7731
Practice Address - Street 1:915 MAINSTREET
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7565
Practice Address - Country:US
Practice Address - Phone:952-929-1981
Practice Address - Fax:952-206-7731
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN46000002OtherMEDICA CHOICE
MN64601000OtherMEDICA CHOICE
MN334245000Medicaid
MN134612OtherCHOICE PLUS/PATIENT CHOIC
MN05995GROtherBLUE CROSS BLUE SHIELD
MN134612OtherCHOICE PLUS/PATIENT CHOIC