MEDICARE: MISS GRACE CHISHOLM

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	103K00000X	Behavior Analyst	243	CT

General Provider Information

NPI Number	:	1629923230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GRACE CHISHOLM

Provider Business Mailing Address
First Line	:	37 JETLAND PL
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06605-3318
Country	:	US
Telephone Number	:	475-217-1521
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 KINGS HWY E STE 110
Second Line	:
City	:	FAIRFIELD
State	:	CT
Zip	:	06825-4859
Country	:	US
Telephone Number	:	203-856-9195
Fax Number	:

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

Provider Enumeration Date	:	02/27/2026
Last Update Date	:	02/27/2026

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Directions to “ MISS GRACE CHISHOLM ” Practice Location

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