Provider Demographics
NPI:1609895424
Name:GROFF, ROXANNE L (AUD)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:L
Last Name:GROFF
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-589-3137
Mailing Address - Fax:740-566-4049
Practice Address - Street 1:2131 EAST STATE STREET
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1334
Practice Address - Country:US
Practice Address - Phone:740-589-3100
Practice Address - Fax:740-589-3123
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00200231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000204488OtherOHIO MEDICAID UNISON
OHP00640943OtherRAILROAD MEDICARE
OH310917085195OtherOHIO MEDICAID CARESOURCE
OH0098630Medicaid
OHP00640943OtherRAILROAD MEDICARE