Provider Demographics
NPI:1629725692
Name:GROVE, DEBORAH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GROVE
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 1:3019 NADAR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6791
Mailing Address - Country:US
Mailing Address - Phone:972-890-4808
Mailing Address - Fax:
Practice Address - Street 1:100 WALTER STEPHENSON RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-3418
Practice Address - Country:US
Practice Address - Phone:972-890-4808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14230402235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist