Provider Demographics
NPI:1710140538
Name:GROFF, VANESSA ALISON (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ALISON
Last Name:GROFF
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:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0833
Mailing Address - Country:US
Mailing Address - Phone:516-343-4282
Mailing Address - Fax:
Practice Address - Street 1:14 SIMPSON PL # 833
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1723
Practice Address - Country:US
Practice Address - Phone:516-343-4282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist