Individual
MRS. SABRINA LYNNE GRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCC-S
Contact information
Practice address
506 HOLLY AVE, LOGAN, WV 25601-3306
(304) 792-2073
Mailing address
765 DANS BRANCH RD, WILLIAMSON, WV 25661-9122
(304) 235-4099
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12026074
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810010957
—
WA
Enumeration date
01/28/2008
Last updated
01/28/2008
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