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General NPI Number Information
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NPI Number | 1952949034
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Entity Type | Individual
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Provider Name | GRACE EVELYN LUCE RBT
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Gender | Female
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Dates
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Enumeration Date | 12/19/2019
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 1501 W TAPP RD
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City | BLOOMINGTON
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State | IN
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Zip | 47403-3459
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Country | US
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Telephone | 812-330-4460
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Fax | 812-330-4461
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Provider Business Mailing Address
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Address Line | 2495 S WALNUT STREET PIKE
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City | BLOOMINGTON
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State | IN
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Zip | 47401-8431
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Country | US
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Telephone | 812-202-6001
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT--19-85817
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License Number State | IN
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