Provider Demographics
NPI:1528377926
Name:GROB, KAMI HEBERT (MS)
Entity Type:Individual
Prefix:
First Name:KAMI
Middle Name:HEBERT
Last Name:GROB
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 LOBLOLLY PINE DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359-2303
Mailing Address - Country:US
Mailing Address - Phone:985-855-5193
Mailing Address - Fax:
Practice Address - Street 1:152 LOBLOLLY PINE DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359-2303
Practice Address - Country:US
Practice Address - Phone:985-855-5193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-02
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
LA5249235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2126717Medicaid