Healthcare Provider Details

I. General information

NPI: 1376475772
Provider Name (Legal Business Name): GRACE ANN NOLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1127 QUEENSBOROUGH BLVD STE 104
MT PLEASANT SC
29464-5431
US

IV. Provider business mailing address

1127 QUEENSBOROUGH BLVD STE 104
MT PLEASANT SC
29464-5431
US

V. Phone/Fax

Practice location:
  • Phone: 843-216-0290
  • Fax:
Mailing address:
  • Phone: 843-216-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: