Healthcare Provider Details

I. General information

NPI: 1467525659
Provider Name (Legal Business Name): BONNIE L GROSS M.S., M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 S FRANKLIN ST
TITUSVILLE PA
16354-2246
US

IV. Provider business mailing address

452 S FRANKLIN ST
TITUSVILLE PA
16354-2246
US

V. Phone/Fax

Practice location:
  • Phone: 814-827-6648
  • Fax: 814-827-0206
Mailing address:
  • Phone: 814-827-6648
  • Fax: 814-827-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC009990
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT000179-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: