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General NPI Number Information
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NPI Number | 1942833660
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Entity Type | Organization
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Legal Business Name | GRACE SPEECH THERAPY CORP
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Dates
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Enumeration Date | 02/20/2020
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 22672 LAMBERT ST STE 611
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City | LAKE FOREST
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State | CA
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Zip | 92630-1613
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Country | US
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Telephone | 949-329-8161
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Fax |
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Provider Business Mailing Address
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Address Line | 22672 LAMBERT ST STE 611
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City | LAKE FOREST
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State | CA
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Zip | 92630-1613
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Country | US
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Telephone | 714-227-2160
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLAIRE BRUNSTING
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Credential |
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Telephone | 714-227-2160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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