Provider Demographics
NPI:1043877780
Name:GRISSOM, ALAINA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALAINA
Middle Name:
Last Name:GRISSOM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ALAINA
Other - Middle Name:
Other - Last Name:ECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8114
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414-0114
Mailing Address - Country:US
Mailing Address - Phone:423-622-1551
Mailing Address - Fax:877-856-7133
Practice Address - Street 1:6172 AIRWAYS BLVD STE 122
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2915
Practice Address - Country:US
Practice Address - Phone:423-622-1551
Practice Address - Fax:877-856-7133
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6641235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6641OtherHEALTH LICENSE REGISTRATION