Provider Demographics
NPI:1619412525
Name:GROSSART, KATIE A (MA)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:A
Last Name:GROSSART
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 CANHAM ST
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:IL
Mailing Address - Zip Code:60545-3022
Mailing Address - Country:US
Mailing Address - Phone:847-873-4584
Mailing Address - Fax:
Practice Address - Street 1:916 CANHAM ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:IL
Practice Address - Zip Code:60545-3022
Practice Address - Country:US
Practice Address - Phone:847-873-4584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-01
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.004303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist