Individual
MR. CHARLES G GROVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
1325 ANGELS PATH RD, DE PERE, WI 54115-4050
(920) 338-2855
(920) 338-9270
Mailing address
1325 ANGELS PATH RD, DE PERE, WI 54115-4050
(920) 338-2855
(920) 338-9270
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1568-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001244550
MEDICARE
WI
05
—
39266100
—
WI
Enumeration date
08/13/2006
Last updated
01/14/2009
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