Healthcare Provider Details

I. General information

NPI: 1962323782
Provider Name (Legal Business Name): GRAZIELE HIGHLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

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

1320 FORDICE RD
LEBANON IN
46052-1910
US

IV. Provider business mailing address

1320 FORDICE RD
LEBANON IN
46052-1910
US

V. Phone/Fax

Practice location:
  • Phone: 765-482-2000
  • Fax:
Mailing address:
  • Phone: 765-482-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number62951
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: