Healthcare Provider Details

I. General information

NPI: 1659768984
Provider Name (Legal Business Name): LAURA JOANNE GROSS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 E PARENT AVE STE 505
ROYAL OAK MI
48067-3769
US

IV. Provider business mailing address

1491 SPENCER ST
FERNDALE MI
48220-3505
US

V. Phone/Fax

Practice location:
  • Phone: 313-451-0305
  • Fax:
Mailing address:
  • Phone: 313-451-0305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801097606
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: