Individual
GERALDINE GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
41 GLENCOVE AVE, BANGOR, ME 04401-4226
(207) 990-5634
Mailing address
41 GLENCOVE AVE, BANGOR, ME 04401-4226
(207) 990-5634
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP1328
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123223
ANTHEM BLUE CROSS AND BLUE SHIELD OF MAINE
ME
05
—
324660000
—
ME
Enumeration date
11/17/2006
Last updated
12/08/2008
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