MEDICARE: MRS. CHRISTINA ELIZABETH GROTEWIEL MS CCC SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2006006972	MO

General Provider Information

NPI Number	:	1578632683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA ELIZABETH GROTEWIEL MS CCC SLP

Provider Business Mailing Address
First Line	:	3800 MAMBA DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-6234
Country	:	US
Telephone Number	:	660-351-1138
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 MAMBA DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-6234
Country	:	US
Telephone Number	:	660-351-1138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/06/2008

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