Healthcare Provider Details

I. General information

NPI: 1669339230
Provider Name (Legal Business Name): GRACE SUSAN LEVERING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W SHERMAN WAY STE 1
NIXA MO
65714-9022
US

IV. Provider business mailing address

116 W SHERMAN WAY STE 1
NIXA MO
65714-9022
US

V. Phone/Fax

Practice location:
  • Phone: 417-374-7185
  • Fax: 417-374-7185
Mailing address:
  • Phone: 417-374-7185
  • Fax: 417-374-7185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-505642
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: