Healthcare Provider Details

I. General information

NPI: 1861308017
Provider Name (Legal Business Name): GRACE MOHR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 S CHILLICOTHE ST
PLAIN CITY OH
43064-1233
US

IV. Provider business mailing address

1429 RAILSIDE DR UNIT 313
COLUMBUS OH
43215-3365
US

V. Phone/Fax

Practice location:
  • Phone: 614-873-4608
  • Fax:
Mailing address:
  • Phone: 440-679-9993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.20263511-SP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: