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NPI Code Detail

MEDICARE: SALLY GRACEY MS, CCC-SLP

MEDICARE: SALLY GRACEY MS, 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
1235Z00000XSpeech-Language Pathologist16357TX

General Provider Information

NPI Number : 1659638013
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALLY GRACEY MS, CCC-SLP
Provider Business Mailing Address
First Line : 250 SANTA FE DR
Second Line :
City : WEATHERFORD
State : TX
Zip : 76086-6585
Country : US
Telephone Number : 817-550-5058
Fax Number :
Provider Business Practice Location Address
First Line : 250 SANTA FE DR
Second Line :
City : WEATHERFORD
State : TX
Zip : 76086-6585
Country : US
Telephone Number : 817-550-5058
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2012
Last Update Date : 11/07/2016

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Directions to “ SALLY GRACEY MS, CCC-SLP” Practice Location

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