Provider Demographics
NPI:1538284690
Name:GROGG, MARY JILL (MS,CCC,SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JILL
Last Name:GROGG
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 1:200 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3667
Mailing Address - Country:US
Mailing Address - Phone:610-370-2746
Mailing Address - Fax:
Practice Address - Street 1:5501 PERKIOMEN AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3633
Practice Address - Country:US
Practice Address - Phone:610-779-0600
Practice Address - Fax:610-370-2185
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL-003846-L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist