Provider Demographics
NPI:1194276212
Name:GRIGAS, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:GRIGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16792 TALISMAN LN
Mailing Address - Street 2:C209
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3136
Mailing Address - Country:US
Mailing Address - Phone:916-899-7790
Mailing Address - Fax:
Practice Address - Street 1:16792 TALISMAN LN
Practice Address - Street 2:C209
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-3136
Practice Address - Country:US
Practice Address - Phone:916-899-7790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP24854235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist