Provider Demographics
NPI:1700175668
Name:GROTHE, MELISSA ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:GROTHE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 MORGAN AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2079
Mailing Address - Country:US
Mailing Address - Phone:361-816-3637
Mailing Address - Fax:877-864-2302
Practice Address - Street 1:810 MORGAN AVE
Practice Address - Street 2:APT. 3
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2079
Practice Address - Country:US
Practice Address - Phone:361-816-3637
Practice Address - Fax:877-864-2302
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105996235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist