Provider Demographics
NPI:1770966061
Name:GROSSMAN, TALIA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:GROSSMAN
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 1:15 CITY VIEW RD APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2202
Mailing Address - Country:US
Mailing Address - Phone:781-801-4688
Mailing Address - Fax:
Practice Address - Street 1:15 CITY VIEW RD APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2202
Practice Address - Country:US
Practice Address - Phone:781-801-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-04
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist