Individual
HEIDI ELIZABETH GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
155 LIBERTY ST NE, SUITE 360, SALEM, OR 97301-3505
(503) 507-3847
Mailing address
155 LIBERTY ST NE, SUITE 360, SALEM, OR 97301-3505
(503) 507-3847
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
10761
OR
Other
Enumeration date
11/24/2009
Last updated
11/24/2009
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