Provider Demographics
NPI:1184848228
Name:GROS, RONNA ANN (MCD)
Entity Type:Individual
Prefix:
First Name:RONNA
Middle Name:ANN
Last Name:GROS
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1972 ORMOND BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-3818
Mailing Address - Country:US
Mailing Address - Phone:504-388-1601
Mailing Address - Fax:985-764-1601
Practice Address - Street 1:1972 ORMOND BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-3818
Practice Address - Country:US
Practice Address - Phone:504-388-1601
Practice Address - Fax:985-764-1601
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1332186Medicaid