Provider Demographics
NPI:1700398344
Name:GRATEFUL HEALING, LLC
Entity Type:Organization
Organization Name:GRATEFUL HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOUSEKNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:607-368-5050
Mailing Address - Street 1:246 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-5888
Mailing Address - Country:US
Mailing Address - Phone:607-368-5050
Mailing Address - Fax:
Practice Address - Street 1:246 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5888
Practice Address - Country:US
Practice Address - Phone:978-854-5798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7444235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty