Provider Demographics
NPI:1417548041
Name:WARDROP, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WARDROP
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 1:3106 S WS YOUNG DR.
Mailing Address - Street 2:BLDG. A, SUITE 104/105
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542
Mailing Address - Country:US
Mailing Address - Phone:512-998-7438
Mailing Address - Fax:
Practice Address - Street 1:3106 S WS YOUNG DR.
Practice Address - Street 2:BLDG. A, SUITE 104/105
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542
Practice Address - Country:US
Practice Address - Phone:512-998-7438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician