Provider Demographics
NPI:1205956356
Name:GROVER, MARY C (MA, CCC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:GROVER
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:GROVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA,CCC
Mailing Address - Street 1:15538 COVELLO ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3341
Mailing Address - Country:US
Mailing Address - Phone:818-787-7664
Mailing Address - Fax:818-780-0698
Practice Address - Street 1:15538 COVELLO ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3341
Practice Address - Country:US
Practice Address - Phone:818-787-7664
Practice Address - Fax:818-780-0698
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP5279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist