Ellen Rebecca Grade

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP009786 Issued in GA

Practice address

3105 Creekside Village Dr NW Ste 604
Kennesaw, GA 30144-4218

Phone

(770) 974-2424

NPI assigned

Jan 23, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dynamic Therapy Associates, Inc

  • Speech-Language Pathologist
  • Kennesaw, GA
  • NPI 1750359808
  NPD (past)

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

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548201600000",
    "number": "1447714472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 26TH ST NW APT 6207",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091929",
            "telephone_number": "678-910-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 CREEKSIDE VILLAGE DR NW STE 604",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301444218",
            "telephone_number": "770-974-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRADE",
        "first_name": "ELLEN",
        "middle_name": "REBECCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-23",
        "last_updated": "2019-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP009786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isabelle Gonzales
• Anniz Gonzalez
• Chelsea Gonzalez, D.O.
• Lane Gormley, LPC
• Anna Harrell Gould
• Yolanda Patrice Graham, M.D.
• Julie Renee Graiser, NP-C
• Alim Jamal Grant, D.D.S
• Erica Michelle Grant, LCSW
• Xavier Granville

• Speech-Language Pathologist in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; 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.