Healthcare Provider Details

I. General information

NPI: 1649817271
Provider Name (Legal Business Name): STEPHANIE GROSPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE DANG

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 E BIRCH ST STE 102
BREA CA
92821-6261
US

IV. Provider business mailing address

1055 E COLORADO BLVD STE 560
PASADENA CA
91106-2380
US

V. Phone/Fax

Practice location:
  • Phone: 657-444-9002
  • Fax:
Mailing address:
  • Phone: 818-241-6780
  • Fax: 818-241-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number40057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: