MEDICARE: GRACE LOEW M.S. CCC-SLP

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	6124	WI
2	235Z00000X	Speech-Language Pathologist	SP.13708	OH

General Provider Information

NPI Number	:	1285334334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE LOEW M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	2000 W STANFIELD RD
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-2572
Country	:	US
Telephone Number	:	937-339-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3625 LITTLE YORK RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-2454
Country	:	US
Telephone Number	:	937-415-7000
Fax Number	:

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

Provider Enumeration Date	:	03/07/2023
Last Update Date	:	08/15/2024

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Directions to “ GRACE LOEW M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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