Angela Kim Grissom, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

S2357 Issued in MS

Practice address

733 N. Flag Chapel Road
Jackson, MS 39209

Phone

(601) 922-5530

Fax

(601) 922-5534

NPI assigned

Dec 17, 2008

Last updated

Sep 30, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kim Tidwell Other name

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Magnolia Speech School

  • Audiologist
  • Jackson, MS
  • NPI 1316163389

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1229472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759190400000",
    "number": "1770729998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 PECAN HILL DR",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390565233",
            "telephone_number": "601-862-9265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "733 N. FLAG CHAPEL ROAD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39209",
            "telephone_number": "601-922-5530",
            "fax_number": "601-922-5534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISSOM",
        "first_name": "ANGELA",
        "middle_name": "KIM",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-17",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S2357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MS STATE BOARD OF HEALTH",
            "identifier": "S2357",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "TIDWELL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Patrice Nicole Griffith, DMD
• Shagaria Griffith
• Hannah C Griggs
• Lauren Ashley Grillis, AU.D.
• Jonathan Grisiaffi
• Charles Grogan, MD
• Graham Grogan, MD
• Kaley Grant Grogan, FNP-C
• Martin Christopher Groke
• Deborah Virginia Gross, MD

• Speech-Language Pathologist in Jackson, MS
• Providers in Jackson, MS by specialty
• Speech-Language Pathologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2025; 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.