Healthcare Provider Details

I. General information

NPI: 1326969148
Provider Name (Legal Business Name): GRACE HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1752 E BULLARD AVE STE 101
FRESNO CA
93710-5864
US

IV. Provider business mailing address

1161 E SHEPHERD AVE APT 209
FRESNO CA
93720-2046
US

V. Phone/Fax

Practice location:
  • Phone: 559-970-8277
  • Fax:
Mailing address:
  • Phone: 559-474-9739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: