Provider Demographics
NPI:1164611976
Name:CHAO, GRACE C (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:C
Last Name:CHAO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NEWPORT CENTER DRIVE
Mailing Address - Street 2:#200
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6980
Mailing Address - Country:US
Mailing Address - Phone:949-874-0922
Mailing Address - Fax:949-644-1560
Practice Address - Street 1:120 NEWPORT CENTER DRIVE
Practice Address - Street 2:#200
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6980
Practice Address - Country:US
Practice Address - Phone:949-874-0922
Practice Address - Fax:949-644-1560
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist