Provider Demographics
NPI:1760266464
Name:KLEIN, GRACE KATHLEEN (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:KATHLEEN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4552 N BARWICK RANCH CIR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3532
Mailing Address - Country:US
Mailing Address - Phone:561-789-8074
Mailing Address - Fax:
Practice Address - Street 1:861 W MORSE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3746
Practice Address - Country:US
Practice Address - Phone:407-637-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-09-15
Deactivation Date:2023-09-06
Deactivation Code:
Reactivation Date:2023-09-14
Provider Licenses
StateLicense IDTaxonomies
FLSZ11593235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist