Provider Demographics
NPI:1104065101
Name:GROSS, TONI A (MA, SLP)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:A
Last Name:GROSS
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 FAIRWAY VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-4829
Mailing Address - Country:US
Mailing Address - Phone:575-312-8576
Mailing Address - Fax:517-338-6196
Practice Address - Street 1:1512 FAIRWAY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-4829
Practice Address - Country:US
Practice Address - Phone:575-312-8576
Practice Address - Fax:517-338-6196
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1588235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist