Provider Demographics
NPI:1043435811
Name:GROSSMAN, STEFANIE LYNN (MA)
Entity Type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:LYNN
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 MAHAILA AVE
Mailing Address - Street 2:APT D 13
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5732
Mailing Address - Country:US
Mailing Address - Phone:617-448-8582
Mailing Address - Fax:
Practice Address - Street 1:3950 MAHAILA AVE
Practice Address - Street 2:APT D 13
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5732
Practice Address - Country:US
Practice Address - Phone:617-448-8582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist