Individual
GRACE FASNUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
12110 CLAYTON RD, SAINT LOUIS, MO 63131-2516
(314) 989-8100
Mailing address
12110 CLAYTON RD, SAINT LOUIS, MO 63131-2516
(314) 989-8100
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2016022605
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
506112408
—
MO
Enumeration date
11/04/2016
Last updated
08/26/2022
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