Provider Demographics
NPI:1467784116
Name:MARY GROVER
Entity Type:Organization
Organization Name:MARY GROVER
Other - Org Name:GROVER VOICE AND SPEECH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:818-787-7664
Mailing Address - Street 1:15538 COVELLO STREET
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3341
Mailing Address - Country:US
Mailing Address - Phone:818-787-7664
Mailing Address - Fax:818-780-0698
Practice Address - Street 1:15538 COVELLO STREET
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3341
Practice Address - Country:US
Practice Address - Phone:818-787-7664
Practice Address - Fax:818-780-0698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP5279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty