Individual
THOMAS GROH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1095 MIDWAY RD, MENASHA, WI 54952-1115
(920) 720-2300
Mailing address
PO BOX 8003, APPLETON, WI 54912-8003
(920) 996-3298
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
614-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39007500
—
WI
Enumeration date
11/29/2006
Last updated
07/08/2007
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