MEDICARE: GRACE ELISABETH WARREN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	30003766	NC

General Provider Information

NPI Number	:	1265234678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE ELISABETH WARREN

Provider Business Mailing Address
First Line	:	3500 DEPAUW BLVD STE 3070
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6135
Country	:	US
Telephone Number	:	855-324-0885
Fax Number	:	317-520-8200

Provider Business Practice Location Address
First Line	:	8430 UNIVERSITY EXEC PARK DR STE 685
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-1337
Country	:	US
Telephone Number	:	980-265-3778
Fax Number	:	317-520-8200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2025
Last Update Date	:	04/15/2025

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Directions to “ GRACE ELISABETH WARREN ” Practice Location

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