Provider Demographics
NPI:1073667549
Name:GROLNIC, STEPHEN SIDNEY (AUD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SIDNEY
Last Name:GROLNIC
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 1:12 QUILL CIR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2959
Mailing Address - Country:US
Mailing Address - Phone:508-875-9773
Mailing Address - Fax:781-986-8721
Practice Address - Street 1:664 WAVERLY ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8554
Practice Address - Country:US
Practice Address - Phone:508-875-9773
Practice Address - Fax:781-986-8721
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA96237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter