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General NPI Number Information
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NPI Number | 1295890382
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Entity Type | Individual
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Provider Name | CARRIE GROHOL MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 91 HOSPITAL DR
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City | TOWANDA
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State | PA
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Zip | 18848-9702
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Country | US
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Telephone | 570-268-2385
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Fax | 570-268-2379
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Provider Business Mailing Address
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Address Line | 91 HOSPITAL DR
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City | TOWANDA
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State | PA
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Zip | 18848-9702
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Country | US
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Telephone | 570-268-2385
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Fax | 570-268-2379
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SL007557
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License Number State | PA
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Legacy Identifiers
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Identifier #1
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Identifier Code | 001961411
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Identifier Type | OTHER
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Identifier State | PA
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Identifier Issuer | MA NUMBER
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 001961411
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Identifier Type | OTHER
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Identifier State | PA
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Identifier Issuer | MA NUMBER
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