Provider Demographics
NPI:1184171373
Name:GROBMAN, ILENE NICOLE (MS,CCC/SLP,TSHH)
Entity type:Individual
Prefix:MRS
First Name:ILENE
Middle Name:NICOLE
Last Name:GROBMAN
Suffix:
Gender:F
Credentials:MS,CCC/SLP,TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WILMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4026
Mailing Address - Country:US
Mailing Address - Phone:516-521-5579
Mailing Address - Fax:
Practice Address - Street 1:24 WILMINGTON DR
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4026
Practice Address - Country:US
Practice Address - Phone:516-521-5579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013159235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist