Individual
GRACIE FAITH WALSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
85 RADIO STATION RD, LEBANON, KY 40033-8166
(270) 692-7127
Mailing address
85 RADIO STATION RD, LEBANON, KY 40033-8166
(270) 692-7127
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
851895781
—
KY
Enumeration date
06/03/2026
Last updated
06/03/2026
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