Provider Demographics
NPI:1558463026
Name:GROSSMAN, DINA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DINA
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15815 MENTON BAY CT
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-9740
Mailing Address - Country:US
Mailing Address - Phone:561-865-0697
Mailing Address - Fax:
Practice Address - Street 1:15815 MENTON BAY CT
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-9740
Practice Address - Country:US
Practice Address - Phone:561-865-0697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888813200Medicaid