Provider Demographics
NPI:1033577275
Name:GROSSMAN, CHAD HUNTER
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:HUNTER
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 KEN PRATT BLVD STE 120-1005
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-8993
Mailing Address - Country:US
Mailing Address - Phone:215-262-6937
Mailing Address - Fax:
Practice Address - Street 1:205 KEN PRATT BLVD STE 120-1005
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8993
Practice Address - Country:US
Practice Address - Phone:215-262-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16099235Z00000X
NY026094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04513879Medicaid
FL103190400Medicaid