Provider Demographics
NPI:1720636582
Name:GRUNDER, EVELYN RUTH (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:RUTH
Last Name:GRUNDER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 BEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-6261
Mailing Address - Country:US
Mailing Address - Phone:214-998-7346
Mailing Address - Fax:
Practice Address - Street 1:375 BEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-6261
Practice Address - Country:US
Practice Address - Phone:214-998-7346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2024-07-25
Deactivation Date:2023-12-20
Deactivation Code:
Reactivation Date:2024-01-31
Provider Licenses
StateLicense IDTaxonomies
AL5464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist