Provider Demographics
NPI:1679212179
Name:GRO SPEECH LLC
Entity Type:Organization
Organization Name:GRO SPEECH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEGRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:860-869-4997
Mailing Address - Street 1:2075 CHARLOTTE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-2729
Mailing Address - Country:US
Mailing Address - Phone:860-869-4997
Mailing Address - Fax:
Practice Address - Street 1:2075 CHARLOTTE ST STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2729
Practice Address - Country:US
Practice Address - Phone:860-869-4997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech