Provider Demographics
NPI:1386867919
Name:GROVE, JANET E (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:E
Last Name:GROVE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 PRAIRIE PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3168
Mailing Address - Country:US
Mailing Address - Phone:701-356-7766
Mailing Address - Fax:701-356-7765
Practice Address - Street 1:1150 PRAIRIE PKWY STE 105
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3168
Practice Address - Country:US
Practice Address - Phone:701-356-7766
Practice Address - Fax:701-356-7765
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND51043Medicaid
ND26666OtherND BCBS