Healthcare Provider Details

I. General information

NPI: 1992013486
Provider Name (Legal Business Name): GRACE LIU M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10901 176TH CIR NE
REDMOND WA
98052-7218
US

IV. Provider business mailing address

11532 9TH AVE NE
SEATTLE WA
98125-6212
US

V. Phone/Fax

Practice location:
  • Phone: 706-614-7229
  • Fax:
Mailing address:
  • Phone: 706-614-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number021200
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL60247561
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: