Provider Demographics
NPI:1700018827
Name:GRONEWALD, TINA ELISE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:ELISE
Last Name:GRONEWALD
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 1:1540 SUNDAY DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6010
Mailing Address - Country:US
Mailing Address - Phone:919-782-3456
Mailing Address - Fax:919-719-3531
Practice Address - Street 1:1540 SUNDAY DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6010
Practice Address - Country:US
Practice Address - Phone:919-782-3456
Practice Address - Fax:919-719-3531
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8640235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist