Provider Demographics
NPI:1063027647
Name:GROSSO, GINA DANNIELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:DANNIELLE
Last Name:GROSSO
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 1:1126 31ST ST NW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-3723
Mailing Address - Country:US
Mailing Address - Phone:530-521-2742
Mailing Address - Fax:
Practice Address - Street 1:711 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5662
Practice Address - Country:US
Practice Address - Phone:253-931-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61078219235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist