Michael J Granahan, MA CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Lindenhurst, IL
NPI 1104003334 · NPPES record last updated Jan 30, 2008
Key facts
- NPI
- 1104003334
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- Practice address
- 2592 E Grand Ave Ste 209
Lindenhurst, IL 60046-5915 - Phone
- (847) 265-1460
- NPI assigned
- Jan 30, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146007138 | IL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Therapy and Rehab Specialists | Past | Accepting new patients | |
| Hope'S Playground Pediatric Therapy, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | IL | Yes |
Addresses
Primary practice location
2592 E Grand Ave Ste 209
Lindenhurst, IL 60046-5915
Mailing address
2592 E Grand Ave Ste 209
Lindenhurst, IL 60046-5915
Phone (847) 265-1460
Other providers in Lindenhurst, IL
- Genrikh Gandelsman
- Genrikh Gandelsman DDS MSD LTD
- Brian C. Gniadek
- Richard L Goodson
- Jessica Goschy
- Kenneth John Groh
- Lauren Gruber
- Ivalis Anita Guajardo
- Sarah Gurchak
- Janet Haro
All providers in Lindenhurst, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.