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General NPI Number Information
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NPI Number | 1780793950
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Entity Type | Individual
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Provider Name | LISA RACHEL GROSSMAN ED.D, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 6810 NORTH STATE ROAD 7
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City | COCONUT CREEK
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State | FL
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Zip | 33073
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Country | US
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Telephone | 954-617-8138
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Fax | 954-905-4382
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Provider Business Mailing Address
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Address Line | 8267 NW 107TH TER
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City | PARKLAND
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State | FL
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Zip | 33076-4766
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Country | US
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Telephone | 954-257-6043
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Fax | 954-905-4382
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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 | SA5302
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License Number State | FL
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