Provider Demographics
NPI:1962903708
Name:GROSS, GINA (LICSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GROSS
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2015 NW 61ST ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2403
Mailing Address - Country:US
Mailing Address - Phone:414-530-2547
Mailing Address - Fax:
Practice Address - Street 1:2015 NW 61ST ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-2403
Practice Address - Country:US
Practice Address - Phone:414-530-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1092-122104100000X, 1041C0700X
WALW611746241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker