Provider Demographics
NPI:1073295424
Name:GRASL, KODA LYNNE
Entity Type:Individual
Prefix:
First Name:KODA
Middle Name:LYNNE
Last Name:GRASL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:LYNNE
Other - Last Name:GRASL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46201 ALLENTON DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5222
Mailing Address - Country:US
Mailing Address - Phone:586-216-3231
Mailing Address - Fax:
Practice Address - Street 1:15600 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3502
Practice Address - Country:US
Practice Address - Phone:586-263-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator