Healthcare Provider Details

I. General information

NPI: 1639751712
Provider Name (Legal Business Name): GRACE E NORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 ROOSEVELT RD
GLEN ELLYN IL
60137-7829
US

IV. Provider business mailing address

31-21 MEDINAH DR
LANARK IL
61046-9393
US

V. Phone/Fax

Practice location:
  • Phone: 630-580-0853
  • Fax:
Mailing address:
  • Phone: 815-291-9523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-66476
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: