Carissa Grevengoed, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

78648-SP-SL Issued in MA

Practice address

96 Forest St
Peabody, MA 01960-3907

Phone

(772) 480-7068

NPI assigned

Feb 1, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1073104055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3730 7TH TER STE 202",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329607325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 FOREST ST",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019603907",
            "telephone_number": "772-480-7068"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3730 7th Ter Ste 202",
            "address_purpose": "LOCATION",
            "city": "Vero Beach",
            "state": "FL",
            "postal_code": "329607325",
            "country_code": "US",
            "telephone_number": "772-480-7068",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREVENGOED",
        "first_name": "CARISSA",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-01",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "9936",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MA",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MA",
            "license": "78648-SP-SL",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Peabody, MA
• Providers in Peabody, MA by specialty
• Speech-Language Pathologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.