Provider Demographics
NPI:1720213143
Name:NYBLADE, GRACE IRENE (MSW)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:IRENE
Last Name:NYBLADE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:IRENE
Other - Last Name:SANTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1769 NEWKIRK RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9387
Mailing Address - Country:US
Mailing Address - Phone:202-487-8450
Mailing Address - Fax:443-279-0738
Practice Address - Street 1:1769 NEWKIRK RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9387
Practice Address - Country:US
Practice Address - Phone:202-487-8450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129611041C0700X
DCLC500781461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical