Provider Demographics
NPI:1912906884
Name:IRWIN-GROLEAU, DAWN ELAINE (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:ELAINE
Last Name:IRWIN-GROLEAU
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 OLDE W CHOCOLATE AVE
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-9188
Mailing Address - Country:US
Mailing Address - Phone:717-833-5305
Mailing Address - Fax:
Practice Address - Street 1:1135 OLDE W CHOCOLATE AVE
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-9188
Practice Address - Country:US
Practice Address - Phone:717-833-5305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004120L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01849420Medicaid
PA20036905OtherAMERIHEALTH MERCY
PA02249901OtherCAPITAL BLUE CROSS
PAIR1300111OtherHIGHMARK BLUE SHIELD
PA2586470OtherAETNA US HEALTHCARE HMO
PA1537903OtherGATEWAY
PA7083250OtherAETNA US HEALTHCARE PPO