Provider Demographics
NPI:1427022045
Name:GROTE, MARY JO (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:
Last Name:GROTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8650 SUDLEY RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4416
Mailing Address - Country:US
Mailing Address - Phone:703-369-0300
Mailing Address - Fax:703-369-0017
Practice Address - Street 1:8650 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4419
Practice Address - Country:US
Practice Address - Phone:703-369-0300
Practice Address - Fax:703-369-0017
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000555231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54/1804291-001OtherCIGNA
VA0007472511OtherAETNA- PPO
VA541804291OtherGREAT WEST
VA265673OtherALLIANCE
VA3311009OtherAETNA- HMO
VA541804291OtherPHCS
VA5518-0001OtherCAREFIRST BCBS
VA272803OtherBLUE CROSS BLUE SHIELD
VA265673OtherMAMSI, OPTIMUM, MDIPA
VA9460144Medicaid
VA541804291OtherPHCS