Provider Demographics
NPI:1023370004
Name:GROSCHEN, MATTHEW (AUD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:GROSCHEN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2638
Mailing Address - Country:US
Mailing Address - Phone:651-645-6221
Mailing Address - Fax:651-645-9083
Practice Address - Street 1:982 THOMAS AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2638
Practice Address - Country:US
Practice Address - Phone:651-645-6221
Practice Address - Fax:651-645-9083
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8831231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist