Healthcare Provider Details

I. General information

NPI: 1003722695
Provider Name (Legal Business Name): GRACE CAROLINE MATHEWS MS, LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 GOLF RD STE 107
EAU CLAIRE WI
54701-7073
US

IV. Provider business mailing address

3119 GOLF RD STE 107
EAU CLAIRE WI
54701-7073
US

V. Phone/Fax

Practice location:
  • Phone: 715-201-4209
  • Fax: 888-423-1002
Mailing address:
  • Phone: 715-201-4209
  • Fax: 888-423-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9263-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: