Provider Demographics
NPI:1104376532
Name:GRONER, LAURA ANN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:GRONER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SAGO LN
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4369
Mailing Address - Country:US
Mailing Address - Phone:704-293-6552
Mailing Address - Fax:704-662-3304
Practice Address - Street 1:111 SAGO LN
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-4369
Practice Address - Country:US
Practice Address - Phone:704-293-6552
Practice Address - Fax:704-662-3304
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist