Provider Demographics
NPI:1376838284
Name:VAN-NIEL, GRACE JOSEFA
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:JOSEFA
Last Name:VAN-NIEL
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 1:1209 COTTON ARBOR TRCE
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-7412
Mailing Address - Country:US
Mailing Address - Phone:305-479-3780
Mailing Address - Fax:
Practice Address - Street 1:1209 COTTON ARBOR TRCE
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-7412
Practice Address - Country:US
Practice Address - Phone:305-479-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5427235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist