Provider Demographics
NPI:1558081133
Name:TATEOKA, GRACE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:TATEOKA
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S FARMVIEW DR APT N36
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-8220
Mailing Address - Country:US
Mailing Address - Phone:262-501-6330
Mailing Address - Fax:
Practice Address - Street 1:365 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1010
Practice Address - Country:US
Practice Address - Phone:302-653-8589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist