Provider Demographics
NPI:1447219613
Name:GROHE, LINDA S (PHD)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:S
Last Name:GROHE
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 1:213 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-5110
Mailing Address - Country:US
Mailing Address - Phone:712-262-6111
Mailing Address - Fax:712-262-5532
Practice Address - Street 1:20 EAST 4TH STREET
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-5110
Practice Address - Country:US
Practice Address - Phone:712-262-6111
Practice Address - Fax:712-262-5532
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0048702Medicaid
IA25810Medicare ID - Type Unspecified
IA0048702Medicaid