Provider Demographics
NPI:1932064938
Name:GROSSMAN, MELISSA B (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:B
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 WESTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1976
Mailing Address - Country:US
Mailing Address - Phone:612-644-4598
Mailing Address - Fax:
Practice Address - Street 1:1250 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2533
Practice Address - Country:US
Practice Address - Phone:612-668-0254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-22
Last Update Date:2025-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN379378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist