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General NPI Number Information
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NPI Number | 1063362093
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Entity Type | Individual
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Provider Name | JEREMY LAWSON GRACE
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Gender | Male
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Dates
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Enumeration Date | 01/29/2026
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 6200 AURORA AVE STE 305E
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City | URBANDALE
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State | IA
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Zip | 50322-2863
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Country | US
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Telephone | 515-724-8920
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Fax |
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Provider Business Mailing Address
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Address Line | 2409 71ST ST
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City | URBANDALE
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State | IA
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Zip | 50322-4862
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Country | US
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Telephone | 515-991-6499
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 135623
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License Number State | IA
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