Individual
MRS. HEATHER ANN GROMALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
903 MAIN AVE, CRIVITZ, WI 54114-1619
(715) 854-2717
Mailing address
N3238 COUNTY ROAD RW, PESHTIGO, WI 54157-9609
(715) 582-0196
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2554-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12046075
AMERICAN SPEECH LANGUAGE HEARING ASSOCIATION
—
01
—
2554-154
STATE OF WISCONSIN DEPARTMENT OF REGULATION AND LICENSING
WI
05
—
42560000
—
WI
Enumeration date
04/24/2008
Last updated
04/24/2008
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