Healthcare Provider Details

I. General information

NPI: 1780420356
Provider Name (Legal Business Name): GRACE CHERMACK SLP-CF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 E GELDING DR STE B-101
SCOTTSDALE AZ
85260-6948
US

IV. Provider business mailing address

42211 N 41ST DR STE 145
ANTHEM AZ
85086-3812
US

V. Phone/Fax

Practice location:
  • Phone: 602-808-9912
  • Fax:
Mailing address:
  • Phone: 602-808-9912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP15367
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: