Provider Demographics
NPI:1053411603
Name:GROSS, EMILY A (AUD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:A
Last Name:GROSS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:A
Other - Last Name:HAISMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:526 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-3912
Mailing Address - Country:US
Mailing Address - Phone:712-580-4327
Mailing Address - Fax:712-580-4329
Practice Address - Street 1:526 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-3912
Practice Address - Country:US
Practice Address - Phone:712-580-4327
Practice Address - Fax:712-580-4329
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00480231H00000X
IA00758237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist