Individual
MICHELLE GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., LBS
Contact information
Practice address
998 OLD EAGLE SCHOOL RD STE 1206, WAYNE, PA 19087-1805
(215) 219-0233
Mailing address
998 OLD EAGLE SCHOOL RD STE 1206, WAYNE, PA 19087-1805
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH003882
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH003882
BEHAVIOR SPECIALIST LICENSE
PA
Enumeration date
07/15/2019
Last updated
07/15/2019
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