MEDICARE: MOLLY E GROSSE

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	1041C0700X	Clinical Social Worker	7580-123	WI

General Provider Information

NPI Number	:	1194156760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY E GROSSE

Provider Business Mailing Address
First Line	:	5007 S HOWELL AVE STE 350
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-6159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5007 S HOWELL AVE STE 350
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-6159
Country	:	US
Telephone Number	:	262-789-1191
Fax Number	:

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

Provider Enumeration Date	:	12/09/2013
Last Update Date	:	03/25/2024

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Directions to “ MOLLY E GROSSE ” Practice Location

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