Healthcare Provider Details

I. General information

NPI: 1578584363
Provider Name (Legal Business Name): KATHY A GRACE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1734 ELTON RD SUITE 104
SILVER SPRING MD
20903
US

IV. Provider business mailing address

1734 ELTON RD SUITE 104
SILVER SPRING MD
20903
US

V. Phone/Fax

Practice location:
  • Phone: 301-434-4300
  • Fax: 301-434-6299
Mailing address:
  • Phone: 301-434-4300
  • Fax: 301-434-6299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number897
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: