Healthcare Provider Details

I. General information

NPI: 1104515675
Provider Name (Legal Business Name): BRIAN GRACE BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 04/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 S ANKENY BLVD
ANKENY IA
50023-9417
US

IV. Provider business mailing address

1418 NE LITTLE BEAVER DR
GRIMES IA
50111-4506
US

V. Phone/Fax

Practice location:
  • Phone: 515-598-7200
  • Fax:
Mailing address:
  • Phone: 480-466-1349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: