MEDICARE: MARY GRASSE

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1861356362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY GRASSE

Provider Business Mailing Address
First Line	:	250 STURGIS RD
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-8334
Country	:	US
Telephone Number	:	501-513-7903
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 STURGIS RD
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-8334
Country	:	US
Telephone Number	:	501-513-7903
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ MARY GRASSE ” Practice Location

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