Provider Demographics
NPI:1710132097
Name:GROSS, MARILYN ANN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:ANN
Last Name:GROSS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:MARILYN
Other - Middle Name:ANN
Other - Last Name:INSLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:7924 260TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1214
Mailing Address - Country:US
Mailing Address - Phone:718-343-6022
Mailing Address - Fax:
Practice Address - Street 1:9745 QUEENS BLVD
Practice Address - Street 2:SUITE 900
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2116
Practice Address - Country:US
Practice Address - Phone:718-830-9274
Practice Address - Fax:718-830-9276
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-30
Last Update Date:2008-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00-3033-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist