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General NPI Number Information
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NPI Number | 1962203786
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Entity Type | Individual
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Provider Name | GRACE L PALACIOS
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Gender | Female
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 2080 WOODDALE DR STE 200
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City | WOODBURY
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State | MN
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Zip | 55125-2920
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Country | US
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Telephone | 612-201-2468
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Fax |
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Provider Business Mailing Address
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Address Line | 820 28TH AVE N # 1
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City | MENOMONIE
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State | WI
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Zip | 54751-1009
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Country | US
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Telephone | 651-233-7453
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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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