Individual
MRS. GRACE RAISSA GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC SLP
Contact information
Practice address
PRENET FAMILY HEALTH SERVICES, 237 MILLBURY ST, WORCESTER, MA 01610
(508) 755-1228
Mailing address
359 WEST THOMPSON RD, THOMPSON, CT 06277
(860) 963-0267
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5053
MA
Other
Enumeration date
01/19/2007
Last updated
07/08/2007
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