Provider Demographics
NPI:1760107569
Name:GROS-CAMERINO, ELYSSA NICOLE
Entity Type:Individual
Prefix:
First Name:ELYSSA
Middle Name:NICOLE
Last Name:GROS-CAMERINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MOZARTSTRASSE 29
Mailing Address - Street 2:
Mailing Address - City:KAISERSLAUTERN
Mailing Address - State:RHEINLAND-PFALZ
Mailing Address - Zip Code:67655
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MOZARTSTRASSE 29
Practice Address - Street 2:
Practice Address - City:KAISERSLAUTERN
Practice Address - State:RHEINLAND-PFALZ
Practice Address - Zip Code:67655
Practice Address - Country:DE
Practice Address - Phone:414-909-2661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist