Provider Demographics
NPI:1558675884
Name:GROSSMAN, EVELYN ANNE (MS CCC)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:ANNE
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3899 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2644
Mailing Address - Country:US
Mailing Address - Phone:954-270-7030
Mailing Address - Fax:954-963-0034
Practice Address - Street 1:3899 MEADOW LN
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-2644
Practice Address - Country:US
Practice Address - Phone:954-270-7030
Practice Address - Fax:954-963-0034
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2895235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist