Healthcare Provider Details

I. General information

NPI: 1295890382
Provider Name (Legal Business Name): CARRIE GROHOL MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 03/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 HOSPITAL DR
TOWANDA PA
18848-9702
US

IV. Provider business mailing address

91 HOSPITAL DR
TOWANDA PA
18848-9702
US

V. Phone/Fax

Practice location:
  • Phone: 570-268-2385
  • Fax: 570-268-2379
Mailing address:
  • Phone: 570-268-2385
  • Fax: 570-268-2379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL007557
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001961411
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMA NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: