Individual
MARY GRACE SIMASEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
150 POINT O'WOODS RD., WILLLIAMSBURG, VA 23188-7052
(757) 566-3300
(757) 566-8977
Mailing address
PO BOX 280, NORGE, VA 23127-0280
(757) 566-3300
(757) 566-8977
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202000725
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
194411
ANTHEM
VA
01
—
45084
OPTIMA
VA
01
—
49-6679
MEDICARE
VA
05
—
49-7850-1
—
VA
Enumeration date
03/06/2009
Last updated
03/06/2009
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