Individual
GRACE MAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2701 CHESTNUT STATION CT, LOUISVILLE, KY 40299-6395
(800) 335-1060
Mailing address
2412 KESTRAL BLVD APT G, WEST LAFAYETTE, IN 47906-6529
(217) 418-8517
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22009134A
IN
Other
Enumeration date
04/14/2025
Last updated
04/14/2025
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