Provider Demographics
NPI:1083283667
Name:GROSS, LOUIS GREGORY (SLP-CF)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:GREGORY
Last Name:GROSS
Suffix:
Gender:M
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-7712
Mailing Address - Country:US
Mailing Address - Phone:386-383-2914
Mailing Address - Fax:
Practice Address - Street 1:1300 I ST NW STE 400E
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-3318
Practice Address - Country:US
Practice Address - Phone:202-695-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist