Provider Demographics
NPI:1598123259
Name:GRANTZ, ANNE
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:GRANTZ
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 1:5120 DIXIE HWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-1702
Mailing Address - Country:US
Mailing Address - Phone:502-449-0415
Mailing Address - Fax:502-448-7791
Practice Address - Street 1:2133 CHERRY CIR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-9538
Practice Address - Country:US
Practice Address - Phone:812-940-8372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY211225237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
610891280OtherTAX ID NUMBER