MEDICARE: GRACE GEURIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	112555	TX

General Provider Information

NPI Number	:	1073093274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE GEURIN

Provider Business Mailing Address
First Line	:	250 SCHOOL ST
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-4701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 SCHOOL ST
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-4701
Country	:	US
Telephone Number	:	281-516-7929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2018
Last Update Date	:	08/16/2018

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Directions to “ GRACE GEURIN ” Practice Location

Language	Start Address	Practice Location

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