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NPI Code Detail

MEDICARE: MS. MELISSA B GROSSMAN CCC-SLP

MEDICARE: MS. MELISSA B GROSSMAN 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
1235Z00000XSpeech-Language Pathologist379378MN

General Provider Information

NPI Number : 1932064938
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MELISSA B GROSSMAN CCC-SLP
Provider Business Mailing Address
First Line : 2300 WESTRIDGE LN
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55416-1976
Country : US
Telephone Number : 612-644-4598
Fax Number :
Provider Business Practice Location Address
First Line : 1250 W BROADWAY AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-2533
Country : US
Telephone Number : 612-668-0254
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2025
Last Update Date : 12/22/2025

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