Healthcare Provider Details

I. General information

NPI: 1760107569
Provider Name (Legal Business Name): ELYSSA NICOLE GROS-CAMERINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MOZARTSTRASSE 29
KAISERSLAUTERN RHEINLAND-PFALZ
67655
DE

IV. Provider business mailing address

MOZARTSTRASSE 29
KAISERSLAUTERN RHEINLAND-PFALZ
67655
DE

V. Phone/Fax

Practice location:
  • Phone: 414-909-2661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: