MEDICARE: ANDREA GROUT

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	21427	CA

General Provider Information

NPI Number	:	1548124837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA GROUT

Provider Business Mailing Address
First Line	:	2100 TRINKET CIR
Second Line	:
City	:	SAN JACINTO
State	:	CA
Zip	:	92582-2251
Country	:	US
Telephone Number	:	951-892-9048
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 W WILLIAMS ST
Second Line	:
City	:	BANNING
State	:	CA
Zip	:	92220-4746
Country	:	US
Telephone Number	:	951-892-9048
Fax Number	:

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

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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Directions to “ ANDREA GROUT ” Practice Location

Language	Start Address	Practice Location

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