Provider Demographics
NPI:1891310413
Name:GROVE, MARIEL T
Entity Type:Individual
Prefix:
First Name:MARIEL
Middle Name:T
Last Name:GROVE
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 1:1441 E 300 S
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:IN
Mailing Address - Zip Code:46701-9638
Mailing Address - Country:US
Mailing Address - Phone:260-417-5352
Mailing Address - Fax:
Practice Address - Street 1:1441 E 300 S
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IN
Practice Address - Zip Code:46701-9638
Practice Address - Country:US
Practice Address - Phone:260-417-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist