MEDICARE: GRACE CHRISTINE WHIPPLE

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	2355S0801X	Speech-Language Assistant	2355S0801X	CA

General Provider Information

NPI Number	:	1861165219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE CHRISTINE WHIPPLE

Provider Business Mailing Address
First Line	:	5200 CHICAGO AVE APT D12
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-5870
Country	:	US
Telephone Number	:	661-754-2827
Fax Number	:

Provider Business Practice Location Address
First Line	:	5200 CHICAGO AVE APT D12
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-5870
Country	:	US
Telephone Number	:	661-754-2827
Fax Number	:

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

Provider Enumeration Date	:	07/30/2021
Last Update Date	:	07/30/2021

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Directions to “ GRACE CHRISTINE WHIPPLE ” Practice Location

Language	Start Address	Practice Location

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