Provider Demographics
NPI:1619187937
Name:GROSS, ALLISON LEIGH (MT-BC, NMT)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:LEIGH
Last Name:GROSS
Suffix:
Gender:F
Credentials:MT-BC, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6127 S WILSON DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4974
Mailing Address - Country:US
Mailing Address - Phone:480-290-8757
Mailing Address - Fax:
Practice Address - Street 1:6127 S WILSON DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-4974
Practice Address - Country:US
Practice Address - Phone:480-290-8757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225A00000X225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist