Healthcare Provider Details

I. General information

NPI: 1316084411
Provider Name (Legal Business Name): KIRSTEN GROSS M.S.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 S FOREST AVE
TEMPE AZ
85283-2816
US

IV. Provider business mailing address

PO BOX 25150
TEMPE AZ
85285-5150
US

V. Phone/Fax

Practice location:
  • Phone: 480-897-2544
  • Fax: 480-838-1179
Mailing address:
  • Phone: 480-897-2544
  • Fax: 480-838-1179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: