Provider Demographics
NPI:1487923371
Name:HUNT, JOHANNA CLAIRE GROSSER (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:CLAIRE GROSSER
Last Name:HUNT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:CLAIRE
Other - Last Name:GROSSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CF-SLP
Mailing Address - Street 1:7204 TICONDEROGA RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5081
Mailing Address - Country:US
Mailing Address - Phone:262-490-4199
Mailing Address - Fax:
Practice Address - Street 1:6400 UPTOWN BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4202
Practice Address - Country:US
Practice Address - Phone:505-880-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP-2023-0183235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist