Active NPI
Marisa Gross, CCC-LSP
- Rehabilitation Practitioner
- Dickson City, PA
National Provider Identifier
1104800119
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- SL005969 L
- Practice address
- 851 Commerce Blvd
Suite 107
Dickson City, PA 18519-1677 - Phone
- (570) 489-5561
- Fax
- (570) 489-5563
- NPI assigned
- Dec 2, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | SL005969 L | PA | Primary |
| Speech-Language Pathologist | 235Z00000X | SL005969 L | PA |
Addresses
Primary practice location
851 Commerce Blvd
Suite 107
Dickson City, PA 18519-1677
Mailing address
851 Commerce Blvd
Suite 107
Dickson City, PA 18519-1677
Phone (570) 489-5561
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 819172 | Other | PA | FIRST PRIORITY/BC/BS |
| 0018620480005 | Medicaid | PA | |
| 9222541 | Other | PA | PHCS |
| 1353701 | Other | PA | HIGHMARK |
| 163624 | Other | PA | MEDPLUS |
| 2787821 | Other | PA | AETNA HMO |
| 7064341 | Other | PA | AETNA PPO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SL005969 L | PA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1104800119",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "851 COMMERCE BLVD",
"address_2": "SUITE 107",
"city": "DICKSON CITY",
"state": "PA",
"postal_code": "185191677",
"telephone_number": "570-489-5561",
"fax_number": "570-489-5563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "851 COMMERCE BLVD",
"address_2": "SUITE 107",
"city": "DICKSON CITY",
"state": "PA",
"postal_code": "185191677",
"telephone_number": "570-489-5561",
"fax_number": "570-489-5563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROSS",
"first_name": "MARISA",
"credential": "CCC-LSP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-02",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "PA",
"license": "SL005969 L",
"primary": true
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "PA",
"license": "SL005969 L",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST PRIORITY/BC/BS",
"identifier": "819172",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0018620480005",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS",
"identifier": "9222541",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK",
"identifier": "1353701",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDPLUS",
"identifier": "163624",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "2787821",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO",
"identifier": "7064341",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dickson City, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.