Provider Demographics
NPI:1386032381
Name:GRATHWOL, MACY (SLP)
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:GRATHWOL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MACY
Other - Middle Name:
Other - Last Name:LENOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6155 DERBY WAY
Mailing Address - Street 2:
Mailing Address - City:RUTHER GLEN
Mailing Address - State:VA
Mailing Address - Zip Code:22546-2753
Mailing Address - Country:US
Mailing Address - Phone:804-390-5599
Mailing Address - Fax:
Practice Address - Street 1:6155 DERBY WAY
Practice Address - Street 2:
Practice Address - City:RUTHER GLEN
Practice Address - State:VA
Practice Address - Zip Code:22546-2753
Practice Address - Country:US
Practice Address - Phone:804-390-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007559235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist