Provider Demographics
NPI:1568653251
Name:FLICKER, GRACE MARY (MS/SLP/ECE)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:MARY
Last Name:FLICKER
Suffix:
Gender:F
Credentials:MS/SLP/ECE
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26326
Mailing Address - Street 2:YAVAPAI CO. - ESA
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86312-6326
Mailing Address - Country:US
Mailing Address - Phone:928-771-3544
Mailing Address - Fax:928-771-3549
Practice Address - Street 1:8501 E YAVAPAI RD
Practice Address - Street 2:YAVAPAI CO. - ESA
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8622
Practice Address - Country:US
Practice Address - Phone:928-771-3544
Practice Address - Fax:928-771-3549
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ#SLPL0571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist