Organization
GROW OUT LOUD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA MARIE VAN DINTEREN CCC-SLP (OWNER)
(856) 816-7181
Entity
Organization
Contact information
Practice address
3421 E CONSTANCE WAY, PHOENIX, AZ 85042-0012
(856) 816-7181
Mailing address
3421 E CONSTANCE WAY, PHOENIX, AZ 85042-0012
(856) 816-7181
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
05/15/2023
Last updated
05/15/2023
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