Provider Demographics
NPI:1912201195
Name:GROSSMAN, EMILY GEKIDES (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:GEKIDES
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 RIVER OAKS BLVD APT 3J
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3629
Mailing Address - Country:US
Mailing Address - Phone:601-278-3536
Mailing Address - Fax:
Practice Address - Street 1:2501 RIVER OAKS BLVD APT 3J
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3629
Practice Address - Country:US
Practice Address - Phone:601-278-3536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist