Provider Demographics
NPI:1215604038
Name:PADDOCK, GRACE (AUD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 E SOUTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6419
Mailing Address - Country:US
Mailing Address - Phone:682-477-4063
Mailing Address - Fax:682-477-4000
Practice Address - Street 1:1438 E SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6419
Practice Address - Country:US
Practice Address - Phone:682-477-4063
Practice Address - Fax:682-477-4000
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD61204276231H00000X
TX81430231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist