Individual
MRS. MICHELLE GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-A
Contact information
Practice address
258 3RD ST, FORT LUPTON, CO 80621-2010
(303) 857-6688
(303) 857-4156
Mailing address
258 3RD ST, FORT LUPTON, CO 80621-2010
(303) 857-6688
(303) 857-4156
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
35
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01007526
PETI ID ASHA #
CO
05
—
07075260
—
CO
Enumeration date
03/27/2007
Last updated
10/07/2009
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