Provider Demographics
NPI:1508486135
Name:GROTH, TAYLOR (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:GROTH
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 1:1011 1ST ST SE APT 503
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-5338
Mailing Address - Country:US
Mailing Address - Phone:608-695-9020
Mailing Address - Fax:
Practice Address - Street 1:1011 1ST ST SE APT 503
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-5338
Practice Address - Country:US
Practice Address - Phone:608-695-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist