Megan Ann Grissom-Dubenco, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146014880 Issued in IL

Practice address

473 W Army Trail Rd
Bloomington, IL 60108-2674

Phone

(224) 520-8562

Fax

(215) 318-1772

NPI assigned

Jan 29, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Megan Ann Grissom Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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.

• Midwest Speech Therapy, PC

  • Speech-Language Pathologist
  • Bloomingdale, IL
  • NPI 1154780740
  NPD (past)
• Leanne Wright LTD

  • Speech-Language Pathologist
  • Las Vegas, NV
  • NPI 1023456910
  NPD (past)

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

{
    "created_epoch": "1517184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668729600000",
    "number": "1831697465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "473 W ARMY TRAIL RD",
            "address_2": "SUITE 107",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "601082674",
            "telephone_number": "224-520-8562",
            "fax_number": "215-318-1772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "473 W ARMY TRAIL RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "601082674",
            "telephone_number": "224-520-8562",
            "fax_number": "215-318-1772"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7425 W Azure Dr Ste 140",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891304425",
            "country_code": "US",
            "telephone_number": "702-515-4009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRISSOM-DUBENCO",
        "first_name": "MEGAN",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-29",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NV",
            "license": "SP-2076",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146014880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MEGAN",
            "last_name": "GRISSOM",
            "middle_name": "ANN",
            "prefix": "MS.",
            "credential": "M.S., CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Taylor Mae Griem
• M Allan Griffith, MD
• Mariellen Griffith, ED.D.
• Andrea Lynn Grimes
• Barbara Grissinger
• Brittany Gronset, MT-BC
• Alice Dorine Grooms, RN
• Amanda Gruber, DPT
• Gregory V Guard, MD
• Guardian Headache & Pain Management Institute

• Speech-Language Pathologist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2022; 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.