Basic Information
| Provider Information | |||||||||
| NPI: | 1003155342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROSS | ||||||||
| FirstName: | FELICIA | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | M.A., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3361 36TH ST SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495122809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169422522 | ||||||||
| FaxNumber: | 6169563260 | ||||||||
| Practice Location | |||||||||
| Address1: | 3361 36TH ST SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495122809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169422522 | ||||||||
| FaxNumber: | 6169563260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2013 | ||||||||
| LastUpdateDate: | 11/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.