Healthcare Provider Details

I. General information

NPI: 1013758036
Provider Name (Legal Business Name): GRACE LEBLANC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15201A CROWN AT LONE OAK RD
EDMOND OK
73013-2272
US

IV. Provider business mailing address

15201A CROWN AT LONE OAK RD
EDMOND OK
73013-2272
US

V. Phone/Fax

Practice location:
  • Phone: 479-318-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2828443
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: