Provider Demographics
NPI:1467751586
Name:CHANG, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:CHANG
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 1:3970 46TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1408
Mailing Address - Country:US
Mailing Address - Phone:646-251-2340
Mailing Address - Fax:
Practice Address - Street 1:4951 CHAMBERS STREET- 6TH FL
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10007-1209
Practice Address - Country:US
Practice Address - Phone:917-286-5141
Practice Address - Fax:917-286-5142
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist