Provider Demographics
NPI:1003920190
Name:GROSS, BEVERLY JANE (MA, MT-BC)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:JANE
Last Name:GROSS
Suffix:
Gender:F
Credentials:MA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 2ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56514-3438
Mailing Address - Country:US
Mailing Address - Phone:218-354-7494
Mailing Address - Fax:
Practice Address - Street 1:302 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56514-3438
Practice Address - Country:US
Practice Address - Phone:218-354-7494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07006225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist