Provider Demographics
NPI:1033004981
Name:GROTHE, ALISA JOANNE TITZE
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:JOANNE TITZE
Last Name:GROTHE
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 1:4834 BULRUSH BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-5828
Mailing Address - Country:US
Mailing Address - Phone:605-484-6281
Mailing Address - Fax:
Practice Address - Street 1:13810 SHEPHERDS PATH NW
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55379-2455
Practice Address - Country:US
Practice Address - Phone:952-230-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
8665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist