Provider Demographics
NPI:1689235368
Name:LEMON, GRACIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:GRACIE
Middle Name:
Last Name:LEMON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:GRACIE
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CF-SLP
Mailing Address - Street 1:6607 BRODIE LN APT 626
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4651
Mailing Address - Country:US
Mailing Address - Phone:806-470-6633
Mailing Address - Fax:
Practice Address - Street 1:6607 BRODIE LN APT 626
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4651
Practice Address - Country:US
Practice Address - Phone:806-470-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115716235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist