Healthcare Provider Details

I. General information

NPI: 1053257345
Provider Name (Legal Business Name): DANIELLE ELIZABETH GROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W INDEPENDENCE BLVD
MOUNT AIRY NC
27030-3576
US

IV. Provider business mailing address

2109 CHERRYWOOD DR
CLEMMONS NC
27012-9388
US

V. Phone/Fax

Practice location:
  • Phone: 855-983-0488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30004997
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: