Provider Demographics
NPI:1174766315
Name:GRAMM-ROHM, SIVA S (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SIVA
Middle Name:S
Last Name:GRAMM-ROHM
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 N CONCHO DR
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-8137
Mailing Address - Country:US
Mailing Address - Phone:928-692-0138
Mailing Address - Fax:
Practice Address - Street 1:9201 N CONCHO DR
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-8137
Practice Address - Country:US
Practice Address - Phone:928-692-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP-4054235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist