Provider Demographics
NPI:1073779286
Name:GROSHENS, JOSEPH THEODORE
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:THEODORE
Last Name:GROSHENS
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 1:1625 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1845
Mailing Address - Country:US
Mailing Address - Phone:612-216-4687
Mailing Address - Fax:612-216-4627
Practice Address - Street 1:1625 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1845
Practice Address - Country:US
Practice Address - Phone:612-216-4687
Practice Address - Fax:612-216-4627
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker