Provider Demographics
NPI:1235900127
Name:PURIFOY, GRACIE
Entity Type:Individual
Prefix:
First Name:GRACIE
Middle Name:
Last Name:PURIFOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 RED DEER LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1874
Mailing Address - Country:US
Mailing Address - Phone:409-782-9809
Mailing Address - Fax:
Practice Address - Street 1:25420 KUYKENDAHL RD STE F300
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3443
Practice Address - Country:US
Practice Address - Phone:832-356-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX436352355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant