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General NPI Number Information
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NPI Number | 1679857080
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Entity Type | Organization
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Legal Business Name | ERICA L. GRUB PA
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 1500 WESTON RD SUITE 214
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City | WESTON
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State | FL
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Zip | 33326-3263
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Country | US
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Telephone | 954-439-4148
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 WESTON RD SUITE 214
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City | WESTON
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State | FL
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Zip | 33326-3263
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Country | US
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Telephone | 954-439-4148
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MRS. ERICA GRUB
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Credential | SLP
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Telephone | 954-439-4148
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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 | SA6217
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License Number State | FL
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