Healthcare Provider Details

I. General information

NPI: 1942833660
Provider Name (Legal Business Name): GRACE SPEECH THERAPY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22672 LAMBERT ST STE 611
LAKE FOREST CA
92630-1613
US

IV. Provider business mailing address

22672 LAMBERT ST STE 611
LAKE FOREST CA
92630-1613
US

V. Phone/Fax

Practice location:
  • Phone: 949-329-8161
  • Fax:
Mailing address:
  • Phone: 714-227-2160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CLAIRE BRUNSTING
Title or Position: OWNER
Credential:
Phone: 714-227-2160