MEDICARE: SARAH BROOKE GROSS SLPD, 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	20205	CA

General Provider Information

NPI Number	:	1801538350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH BROOKE GROSS SLPD, CCC-SLP

Provider Business Mailing Address
First Line	:	2657 IVANHOE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-2602
Country	:	US
Telephone Number	:	818-590-9666
Fax Number	:

Provider Business Practice Location Address
First Line	:	3637 MOTOR AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-5761
Country	:	US
Telephone Number	:	323-906-7360
Fax Number	:

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

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	12/30/2024

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