Provider Demographics
NPI:1295597532
Name:GROLL, KATHY JEAN
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:JEAN
Last Name:GROLL
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 1:5541 PAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-1914
Mailing Address - Country:US
Mailing Address - Phone:419-508-4426
Mailing Address - Fax:
Practice Address - Street 1:2424 LOGWOOD CT
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-8960
Practice Address - Country:US
Practice Address - Phone:903-570-0738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No172A00000XOther Service ProvidersDriver