Individual provider Active NPI

Jenna Dawn Grantz, M.S. CCC-SLP

  • Speech-Language Pathologist
  • Dallas, TX
National Provider Identifier
1174903199
Registry record updated Dec 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
46002748A Issued in IN
Practice address
12225 Greenville Ave # 600
Dallas, TX 75243-9362
Phone
(866) 575-9820
NPI assigned
Jun 4, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 46002748A IN Primary

Addresses

Primary practice location

12225 Greenville Ave # 600
Dallas, TX 75243-9362

Mailing address

5500 Cambridge CT
Charlestown, IN 47111-9055
Phone (502) 523-9125

Other practice location 1

2701 Chestnut Station Ct
Louisville, KY 40299-6395
Phone (800) 335-1060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
46002748AINMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607904000000",
    "number": "1174903199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 CAMBRIDGE CT",
            "city": "CHARLESTOWN",
            "state": "IN",
            "postal_code": "471119055",
            "telephone_number": "502-523-9125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12225 GREENVILLE AVE # 600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752439362",
            "telephone_number": "866-575-9820"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2701 Chestnut Station Ct",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402996395",
            "country_code": "US",
            "telephone_number": "800-335-1060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRANTZ",
        "first_name": "JENNA",
        "middle_name": "DAWN",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-04",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IN",
            "license": "46002748A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; 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.