Healthcare Provider Details

I. General information

NPI: 1730994948
Provider Name (Legal Business Name): GRACEE PLOUCHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 N KENTUCKY AVE STE C
EVANSVILLE IN
47725-6371
US

IV. Provider business mailing address

8601 N KENTUCKY AVE STE C
EVANSVILLE IN
47725-6371
US

V. Phone/Fax

Practice location:
  • Phone: 812-636-1533
  • Fax: 317-536-3585
Mailing address:
  • Phone: 812-636-1533
  • Fax: 317-536-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: