Healthcare Provider Details

I. General information

NPI: 1043144785
Provider Name (Legal Business Name): GRACIE NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2276 E DEVON CT
GILBERT AZ
85296-3929
US

IV. Provider business mailing address

2276 E DEVON CT
GILBERT AZ
85296-3929
US

V. Phone/Fax

Practice location:
  • Phone: 480-710-8500
  • Fax:
Mailing address:
  • Phone: 480-234-7173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17450
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: