MEDICARE: MRS. MAURA GROSS M.A/, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	0179221	NY

General Provider Information

NPI Number	:	1033362223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAURA GROSS M.A/, CCC-SLP

Provider Business Mailing Address
First Line	:	574 WAVERLY RD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-3422
Country	:	US
Telephone Number	:	914-556-8241
Fax Number	:

Provider Business Practice Location Address
First Line	:	574 WAVERLY RD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-3422
Country	:	US
Telephone Number	:	914-245-1429
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2008
Last Update Date	:	01/05/2012

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