Provider Demographics
NPI:1780793950
Name:GROSSMAN, LISA RACHEL (EDD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:RACHEL
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:EDD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:8267 NW 107TH TER
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4766
Mailing Address - Country:US
Mailing Address - Phone:954-257-6043
Mailing Address - Fax:954-905-4382
Practice Address - Street 1:6810 NORTH STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073
Practice Address - Country:US
Practice Address - Phone:954-617-8138
Practice Address - Fax:954-905-4382
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5302235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884991900Medicaid