Provider Demographics
NPI:1689099772
Name:GROSS, AUSTIN J (IADC)
Entity Type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:J
Last Name:GROSS
Suffix:
Gender:M
Credentials:IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 E KIMBERLY RD STE 200N
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-7216
Mailing Address - Country:US
Mailing Address - Phone:563-355-0055
Mailing Address - Fax:
Practice Address - Street 1:2322 E KIMBERLY RD STE 200N
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-7216
Practice Address - Country:US
Practice Address - Phone:563-355-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA12055101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)