Provider Demographics
NPI:1720825656
Name:GROH, MADDISON
Entity type:Individual
Prefix:
First Name:MADDISON
Middle Name:
Last Name:GROH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2449
Mailing Address - Country:US
Mailing Address - Phone:620-343-2211
Mailing Address - Fax:620-342-1021
Practice Address - Street 1:1000 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2449
Practice Address - Country:US
Practice Address - Phone:620-343-2211
Practice Address - Fax:620-342-1021
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS13780OtherBSRB