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General NPI Number Information
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NPI Number | 1831217058
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Entity Type | Individual
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Provider Name | MICHELLE GROSS M.S.
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 164 W HOSPITALITY LN
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3316
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Country | US
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Telephone | 909-379-1525
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Fax | 909-379-1517
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Provider Business Mailing Address
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Address Line | 7285 GREYLOCK AVE
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City | RIVERSIDE
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State | CA
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Zip | 92504-4920
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Country | US
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Telephone | 951-640-5068
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Fax | 951-780-3235
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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 | SP6770
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License Number State | CA
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