Provider Demographics
NPI:1215019211
Name:GROSSE, JACQUELINE ELIZABETH (MA, CCC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ELIZABETH
Last Name:GROSSE
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15585 NE 68TH CT
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4829
Mailing Address - Country:US
Mailing Address - Phone:831-588-2899
Mailing Address - Fax:
Practice Address - Street 1:7981 168TH AVE NE STE 122
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-0911
Practice Address - Country:US
Practice Address - Phone:831-588-2899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12851235Z00000X
WALL00003852235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist