Healthcare Provider Details

I. General information

NPI: 1659681054
Provider Name (Legal Business Name): GRACE THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 LITCHFIELD LN
W LAFAYETTE IN
47906-8738
US

IV. Provider business mailing address

3719 LITCHFIELD LN
W LAFAYETTE IN
47906-8738
US

V. Phone/Fax

Practice location:
  • Phone: 765-714-2500
  • Fax:
Mailing address:
  • Phone: 765-714-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22003609A
License Number StateIN

VIII. Authorized Official

Name: JOYCE ELIZABETH ASEM
Title or Position: OWNER/SPEECH LANGUAGE PATHOLOGIST
Credential: MS CCC-SLP
Phone: 765-714-2500