Provider Demographics
NPI:1942770268
Name:GROSS, LAURA (SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5979 SIGGELKOW RD
Mailing Address - Street 2:
Mailing Address - City:MC FARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-9817
Mailing Address - Country:US
Mailing Address - Phone:608-838-8999
Mailing Address - Fax:608-838-8988
Practice Address - Street 1:5979 SIGGELKOW RD
Practice Address - Street 2:
Practice Address - City:MC FARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558-9817
Practice Address - Country:US
Practice Address - Phone:608-838-8999
Practice Address - Fax:608-838-8988
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist