Individual provider Active NPI

Ronnie Grijalva

  • Speech-Language Pathologist
  • Rock Hill, SC
National Provider Identifier
1649901257
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
8036 Issued in SC
Practice address
1612 Ebenezer Rd Ste 101
Rock Hill, SC 29732-3862
Phone
(803) 329-9500
Fax
(803) 228-0101
NPI assigned
Jun 23, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

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 8036 SC Primary

Addresses

Primary practice location

1612 Ebenezer Rd Ste 101
Rock Hill, SC 29732-3862

Mailing address

1612 Ebenezer Rd Ste 101
Rock Hill, SC 29732-3862
Phone (803) 329-9500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250315000045 SC Practitioner - Qualified Speech Language Pathologist 9638691900 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8036SCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Collective Therapy Corp. Speech-Language Pathologist CurrentSince Mar 7, 2025 Accepting new patients
Charlotte Neuroscience Foundation PastSince Mar 7, 2025 Accepting new patients
Carolina Therapy Solutions for Kids, LLC Speech-Language Pathologist PastSince Jun 1, 2022 Accepting new patients

Locations

5028 Holloway Dr
Fort Mill, SC 29715
Phone (704) 285-8207

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1655942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1649901257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 EBENEZER RD STE 101",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297323862",
            "telephone_number": "803-329-9500",
            "fax_number": "803-228-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1612 EBENEZER RD STE 101",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297323862",
            "telephone_number": "803-329-9500",
            "fax_number": "803-228-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIJALVA",
        "first_name": "RONNIE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-23",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "8036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Hill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.