Provider Demographics
NPI:1588817217
Name:GROSS, MARNI JILL (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARNI
Middle Name:JILL
Last Name:GROSS
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 1:12 PRITTEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-3527
Mailing Address - Country:US
Mailing Address - Phone:203-775-9681
Mailing Address - Fax:
Practice Address - Street 1:12 PRITTEN HILL RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-3527
Practice Address - Country:US
Practice Address - Phone:203-775-9681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-26
Last Update Date:2008-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010872-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist