Provider Demographics
NPI:1891944997
Name:GROOM, ANNA RACHEL
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:RACHEL
Last Name:GROOM
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 1:15036 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7044
Mailing Address - Country:US
Mailing Address - Phone:636-394-7015
Mailing Address - Fax:
Practice Address - Street 1:15036 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7044
Practice Address - Country:US
Practice Address - Phone:636-394-7015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional