Laura Ann Grube

Individual provider Active NPI Speech-Language Pathologist · Hawthorne, NJ

NPI 1609344191 · NPPES record last updated Nov 2, 2018

Key facts

NPI
1609344191
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
41YS00193500 (NJ)
Practice address
26 Oak PL
Hawthorne, NJ 07506-1807
Phone
(201) 390-8014
NPI assigned
Nov 2, 2018
Sex
Female
Sole proprietor
Yes

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
41YS00193500NJMDSpeech-Language Pathologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 41YS00193500 NJ Yes

Addresses

Primary practice location

26 Oak PL
Hawthorne, NJ 07506-1807

Mailing address

26 Oak PL
Hawthorne, NJ 07506-1807
Phone (201) 390-8014

Other identifiers

IdentifierTypeStateIssuer
41YS00193500OtherNJSPEECH

Other providers in Hawthorne, NJ

All providers in Hawthorne, NJ · Speech-Language Pathologist in New Jersey

Sources for this page

Verify at the official NPI Registry.