Provider Demographics
NPI:1609463017
Name:GATELEY, GRACE L (HIS)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:L
Last Name:GATELEY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2458 E MADRID AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1884
Mailing Address - Country:US
Mailing Address - Phone:417-414-1331
Mailing Address - Fax:
Practice Address - Street 1:2458 E MADRID AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1884
Practice Address - Country:US
Practice Address - Phone:417-414-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020029871237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist