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General NPI Number Information
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NPI Number | 1003301128
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Entity Type | Individual
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Provider Name | GRACE MCINTOSH PPS
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Gender | Female
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Dates
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Enumeration Date | 06/30/2018
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Last Update Date | 06/30/2018
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Provider Practice Location Address
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Address Line | 505 MAIN ST
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City | NEVADA CITY
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State | CA
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Zip | 95959-2218
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Country | US
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Telephone | 530-265-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 13024 BITNEY SPRINGS RD
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City | NEVADA CITY
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State | CA
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Zip | 95959-9017
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Country | US
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Telephone | 530-577-9405
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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