Healthcare Provider Details

I. General information

NPI: 1326398124
Provider Name (Legal Business Name): GRACIE MAE STRAIT-GILG SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7690 NEW MARKET CENTER WAY
COLUMBUS OH
43235-1976
US

IV. Provider business mailing address

4710 CHANTERWOOD DR
COLUMBUS OH
43231-5946
US

V. Phone/Fax

Practice location:
  • Phone: 614-602-6473
  • Fax:
Mailing address:
  • Phone: 702-758-6986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-1473
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP8288
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.12430
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: