Healthcare Provider Details

I. General information

NPI: 1538728993
Provider Name (Legal Business Name): GRACE WEPPNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5160 VILLAGE CREEK DR STE 200
PLANO TX
75093-4423
US

IV. Provider business mailing address

6008 RIDGECREST RD APT 440
DALLAS TX
75231-9350
US

V. Phone/Fax

Practice location:
  • Phone: 682-324-9376
  • Fax:
Mailing address:
  • Phone: 801-698-5635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: