Provider Demographics
NPI:1548306558
Name:GRASSHOFF, VICTORIA (SLP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GRASSHOFF
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 ALBERTI DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5333
Mailing Address - Country:US
Mailing Address - Phone:843-621-2101
Mailing Address - Fax:843-317-9944
Practice Address - Street 1:2812 ALBERTI DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5333
Practice Address - Country:US
Practice Address - Phone:843-621-2101
Practice Address - Fax:843-317-9944
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0273Medicaid