Healthcare Provider Details

I. General information

NPI: 1003155342
Provider Name (Legal Business Name): FELICIA ROSE BROSS M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 36TH ST SE
GRAND RAPIDS MI
49512-2809
US

IV. Provider business mailing address

3361 36TH ST SE
GRAND RAPIDS MI
49512-2809
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-2522
  • Fax: 616-956-3260
Mailing address:
  • Phone: 616-942-2522
  • Fax: 616-956-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: