Provider Demographics
NPI:1336350149
Name:GROSS, SHARI ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHARI
Middle Name:ANN
Last Name:GROSS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 BRIDGE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-1700
Mailing Address - Country:US
Mailing Address - Phone:732-617-8255
Mailing Address - Fax:732-617-8256
Practice Address - Street 1:82 BRIDGE PLAZA DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1700
Practice Address - Country:US
Practice Address - Phone:732-617-8255
Practice Address - Fax:732-617-8256
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00335400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2237321220OtherHORIZON BCBS