Tina Grolley

Individual provider Active NPI Speech-Language Pathologist · Galway, NY

NPI 1467729889 · NPPES record last updated Nov 30, 2011

Key facts

NPI
1467729889
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
0087771 (NY)
Practice address
5317 Sacandaga Rd
Galway, NY 12074-2423
Phone
(518) 882-1291
Fax
(518) 882-5250
NPI assigned
Nov 30, 2011
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
0087771NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Galway Central School Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 0087771 NY Yes

Addresses

Primary practice location

5317 Sacandaga Rd
Galway, NY 12074-2423

Mailing address

37 Russell Rd
Greenfield Center, NY 12833-1318

Other providers in Galway, NY

All providers in Galway, NY · Speech-Language Pathologist in New York

Sources for this page

Verify at the official NPI Registry.