Healthcare Provider Details

I. General information

NPI: 1144182080
Provider Name (Legal Business Name): GRACE KLEA ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24321 COUNTY ROAD 96
DAVIS CA
95616-9532
US

IV. Provider business mailing address

1836 DUNLAP PL
WOODLAND CA
95776-5454
US

V. Phone/Fax

Practice location:
  • Phone: 530-753-1653
  • Fax:
Mailing address:
  • Phone: 530-306-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: