Provider Demographics
NPI:1679175681
Name:GROFF, ALVIN (A.J.) JACKSON III (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:ALVIN (A.J.)
Middle Name:JACKSON
Last Name:GROFF
Suffix:III
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 STUART AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2572
Mailing Address - Country:US
Mailing Address - Phone:484-459-4672
Mailing Address - Fax:
Practice Address - Street 1:219 STUART AVE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2572
Practice Address - Country:US
Practice Address - Phone:484-459-4672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2020708918235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist