Provider Demographics
NPI:1104027622
Name:GROGAN, CHRISTIE L (SLP)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:L
Last Name:GROGAN
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 1:3421 BLUE JAY PASS
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7807
Mailing Address - Country:US
Mailing Address - Phone:540-529-6866
Mailing Address - Fax:
Practice Address - Street 1:3421 BLUE JAY PASS
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7807
Practice Address - Country:US
Practice Address - Phone:540-529-6866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7686235Z00000X
VA2202003815235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist