Provider Demographics
NPI:1114358751
Name:GROSSNER, COLLEEN (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:GROSSNER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 RUTLANDDRIVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2042
Mailing Address - Country:US
Mailing Address - Phone:440-655-1433
Mailing Address - Fax:
Practice Address - Street 1:589 RUTLAND DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2042
Practice Address - Country:US
Practice Address - Phone:440-655-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6179133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered