Provider Demographics
NPI:1730384090
Name:GRANDBOIS, KATHARINE B (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:B
Last Name:GRANDBOIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:L
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 FIELDING ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3401
Mailing Address - Country:US
Mailing Address - Phone:410-924-1200
Mailing Address - Fax:
Practice Address - Street 1:37 FIELDING ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3401
Practice Address - Country:US
Practice Address - Phone:410-925-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12124392235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist