MEDICARE: KIMBERLY GROSSMAN M.S./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	SP-4973	OH

General Provider Information

NPI Number	:	1306264106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY GROSSMAN M.S./CCC-SLP

Provider Business Mailing Address
First Line	:	1 E WREN CIR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45420-2955
Country	:	US
Telephone Number	:	937-499-1858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 E WREN CIR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45420-2955
Country	:	US
Telephone Number	:	937-499-1858
Fax Number	:

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

Provider Enumeration Date	:	03/31/2014
Last Update Date	:	03/31/2014

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Directions to “ KIMBERLY GROSSMAN M.S./CCC-SLP” Practice Location

Language	Start Address	Practice Location

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