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General NPI Number Information
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NPI Number | 1174629786
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Entity Type | Individual
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Provider Name | JANET LOUISE GRACE LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 3111 ELECTRIC AVENUE
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City | PORT HURON
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State | MI
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Zip | 48060-5804
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Country | US
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Telephone | 810-987-7868
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Fax |
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Provider Business Mailing Address
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Address Line | 4430 VINCENT RD
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City | CLYDE
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State | MI
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Zip | 48049-3215
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Country | US
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Telephone | 810-956-4397
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801086268
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License Number State | MI
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